Let me be clear: I'm not American, I've never visited your country though I definitely want to in the near future and I have no experience with your healthcare system.
I'm just a guy from one of those countries with "socialized medicine" who happens to be interested in what's happening on the other side of the Atlantic. Seeing the current fight over public options and co-ops, I thought I'd might just give you my two cents.
I mean, my country, the Netherlands, you know, dopeland, has just abolished the co-ops and has never had a public option. Abolishing the co-ops for private insurers didn't change a thing and a public option isn't even discussed. Nevertheless, we do have universal healthcare and we spend about half as much per capita on health care as you do. So maybe your debate is focusing on the wrong things.
To be fair, I understand why people want a public option. The stories I read about how people are treated by private insurers is pretty horrible. It's not strange that they think that the government will treat them more fair. At the least it can't be worst. But I think this debate is missing the forest for the trees.
I think the real debate is about incentives. Insurers don't treat people badly because they want to, but because it's a rational thing to do. They make a profit by keeping potentially expensive customers out or by trying to push customers out because of "pre-existing conditions." Although this cost them a lot of money, it is still better than paying up for these expensive customers. Basically the insurer who is most adept at screening and kicking out crappy customers (my apologies for my choice of words, I know I'm talkiong about people who need health care, but I'm trying to explain it from the insurer's perspective) will make the highest profit and keep his shareholders happy. Also, it will make the customers who get through the screening happy, as they will pay low premiums, as all the insured with this company are healthy, cheap people.
But from a societal standpoint, it's crap. A lot of money is being spent on this screening and on denying people healthcare they paid for. You don't want companies competing on who is the best on denying people the care they desperately need. You want them to compete on providing the best healthcare for the price paid.
At this moment, the weakest link they can push on to grow their profits is the consumer, who doesn't have the money or the time to stand up to an insurer if he or she is denied healthcare. So, it's morally reprehensible, but completely understandable that insurers push on this weakest link. You would want them to put pressure on hospitals to control costs and provide better care, but why should they if it's easier to push on the consumer?
What I think is the most important thing in your healthcare reform is to repair this inbalance between insurers and insured. You have to make sure that to grow their business insurers have to woo potential customers instead of turning them down and that if they want a bigger profit they have stand up against hospitals to contain costs, instead of containig costs by denying care. To do this, you don't need a public option and you don't need co-ops.
You only need this simple rule: insurers are prohibited to turn anyone down for an insurance. They have an obligation to accept anyone who wants their coverage against the price they are offering. And once someone has paid for this insurance they are obliged to pay for all the actions that the insurance promises it covers. Pre-existing conditions become irrelevant, because they're not allowed to deny payment or coverage.
Suddenly, it's not rational to try and push people out of the coverage, because it's prohibited anyway, so it's impossible to compete on being the better health care denier. Then you'd start trying to be a better health care provider, and if you want to keep your profits high, you'd better start pushing on those health care providers to contain costs.
I welcome your thoughts.