A Public Health Plan Can Lower Costs, Foster Ideas

I have baseball on my mind: It is spring, the teams are on the field, the season has begun. It seems to me that winning the health-care debate is a lot like the Chicago Cubs' winning the World Series—it hasn't happened in forever, and some proponents are hearing the same old refrain of "Wait till next year."

This is usually a safe bet; we have never won the World Series of health care. The last time we even won a big game was in 1997, with the passage of the Children's Health Insurance Plan. Before that, you have to go back to 1965, when we won Medicare and Medicaid.

Those were hard-fought victories, and the opposition then is familiar now. Our current debate has focused on whether reform should offer the choice of a public health-insurance plan. Many of the same arguments against a government-sponsored plan were used at that time, too—chiefly, that a public program will lead to a single-payer health-care system. The claim was nonsense, and nothing more than a shortsighted tactic. Fortunately, Congress didn't fall for it. Medicare is arguably one of the most popular government programs on the books today.

A growing number of Americans already get their health care from a public plan, including Medicare, Medicaid and the Children's Health Insurance Plan (the Department of Veterans Affairs, of course, also provides benefits). There are public-private hybrids as well, like state employee health plans where the government assumes the risk and insurance companies are responsible for the management. The use of a public plan as it is currently proposed is simply an extension of what we have already done in public policy during the last 50 years. We just have to circle the bases.

You get a free pass to first. Americans of all political affiliations overwhelmingly support a public plan. Part of the reason for this is because these plans have a proven track record of offering a far greater choice of doctors than private plans do.

You steal second by recognizing that virtually every objective study has concluded that it will reduce cost in the system—for everyone. The Commonwealth Fund, one of the most respected foundations in the country, recently reported that employer premiums could be substantially lowered with the choice of a public health-insurance plan; a typical American family could save nearly $1,000 a year in reduced premiums alone. If containing costs is one of our biggest goals, how can we not do this?

You take third by showing that a public plan will guarantee improved access to our health-care system. Today more than 47 million Americans have no health insurance at some point during the year. Nearly 50 percent of all Americans don't have the coverage they expect to have when they seek the care they need. A public plan will virtually eliminate the industry practice of rejecting someone based upon health status or ability to pay. Even more, it maximizes portability (without reliance on employment). Finally, as Medicare patients have demonstrated time and time again, they have significantly better access to doctors for routine care of illness or injury than those on employer-based plans do.

You head home by explaining that a public plan is much more likely to be innovative. Expect it to follow the VA model, with the rapid incorporation of health-information technology and electronic medical records. Expect it to employ best practices— and put as much emphasis on wellness as it does illness.

Opponents oftentimes use as their primary argument against a public plan that it presents unfair competition to private insurance companies. I have little doubt that we can level the competitive playing field. Nevertheless, we must realize that reforming the health-care system is, first and foremost, for the American people—not the companies that profit from it.

One final word to the opposing team from the coach's corner: with health reform, Americans are likely going to have some kind of choice. Allow a public health-insurance plan or accept the fact that you are in for far more regulation as we construct a new system without it. With real competition, potentially far less regulation is warranted.

Our team is ready to play; it is a new season, and we've waited a long time. The American people have seen affordable health care for all as something out of "Field of Dreams," and they like what they see. Build it and they will come.

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