Public Health Insurance Plan Is Not An Option

August 23, 2009|By Johanna Neumann

The inclusion of a government-run, public health care plan has become among the most contentious elements of the health reform packages being debated in Congress. Although some argue that a public plan would lead to government-controlled care, it would actually be one insurance option among many, the only difference being cost. Just like a private insurance plan, it would have benefits, co-pays, provider networks and monthly premiums.

The option of a public plan shouldn't seem so controversial. Americans and businesses would be given a choice: Keep the coverage they have, pick another private plan or select a new public health insurance option.

Who's opposed to the public option? The insurance industry is, for starters. Not to mention several key Republican leaders in Congress who are doing their best to assist the industry in defeating it.

None of the opponents disputes the problem of rising health care costs. Health insurance premiums have doubled over the past 10 years. They're set to double again over the next eight. Families and business struggle under the burden of these costs. And the skyrocketing cost of health care has made federal, state and local health care programs more expensive, contributing to Maryland's budget crisis.

And it's not just our wallets that are hurt by exploding health care costs. Last year, more than half of Americans postponed or skipped medical care because of cost.

Opponents of reform don't dispute the issue of rising costs. Karen Ignagni, chief executive officer of the trade group that represents the health insurers, has come out acknowledging the need to reduce the steep growth of health care costs.

Is it that opponents don't think a public option will achieve lower costs? Nope. Ms. Ignagni said in a recent radio interview that a public option is "not just cheaper, it's significantly cheaper."

Instead, the insurance industry and other opponents argue that a public option will dictate the prices that private insurers will pay and that doctors will be forced to take payments so low they will go bankrupt. And yet the American Academy of Family Physicians, National Physicians Alliance, American Medical Student Association and the Student National Medical Association support the public plan.

The reality is that the public option will be well-positioned to implement the type of smart cost controls that the private insurers should have adopted long ago. It could create incentives for primary care, prevention and wellness; pay doctors for good health outcomes, not just the number of tests run and procedures performed; create incentives for utilizing patient-centered research on which drugs and treatments work best; and ignore the hyperbolic sales pitches of drug companies. Once a public health insurance plan begins to implement these programs and realize true cost savings, private insurers will have to follow.

Fearing competition, insurers are offering alternatives that won't achieve the same results. One proposal is to substitute regional co-ops for a true public plan. But co-ops might or might not have the knowledge and clout to implement cost-saving reforms - there's no guarantee that they will. Replacing a true public plan with this untested idea is an intolerable gamble.

We need health care reform now. A key part of this reform must be a public plan option that will free our families, businesses, and government from the burden of the high price of health care. Failure to do so, and our current health care system will cripple our economy and damage our health.

Johanna Neumann is state director of the Maryland Public Interest Research Group. Her e-mail is

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