First let me preface this by stating I favor a single-payer system. That said, such an option would be too radical for our Congress to propose since 40 of the senators will oppose it and the Democrats will split on a conservative public option and only a few will feel willing to promote a single-payer system.
Therefore a public option is the most politically palatable option for health reform, even though it is relatively incremental (Reform, not status quo, May 25, p. 18).
I agree that the system needs to be self-sustaining, but the majority of the public cannot afford the premiums of health insurance now. Their employer picks up some of the tab and a measure of copays and deductibles cost shifts back to the consumer.
Can a new plan be so much less costly than private insurance? To produce a lower premiuma much lower premium. The delivery of care will need to be re-engineered along the preventive primary-care medical home model.
Tort reform is sorely needed to stop unnecessary testing as well as computerized linkage of health systems to also prevent waste. Everything costs money, and the wider the benefit, the more the costs. Remember, too, that to reduce costs by underpaying the providers will result in providers opting out (in a competitive system they will reason that there are other games in town) and no one will be able to access the system.
That is why (barring a single-payer system) I favor bare-bones coverage with deductibles and copayments, and a waiver funded by taxes to pay for the less fortunate. Also I propose add on coverage for a fee that is beyond the minimum. What should the minimum be? Primary gatekeeper-oriented care? Catastrophic phony savings wont be voluntarily contributed (they only promise not to raise future fees by 1.5% less than projected per annum, if we dont enact a public option, i.e., dont enact healthcare reform).
Dont worry about that because it will be taxed upon themlike it or not.
Then private insurance will cost more, small businesses will move their business into the public pool with some add-ons. Then major industry giants might maintain coverage? Generic drugs?
Other unanswered questions: How would the funding be for the first years until the plan is fully self-sustaining? And what if the industry of collecting premiums in exchange for some insurance wont go along? So what if their $2 trillion in a niche or, if they fail, then well sooner than later have a single-payer system for all Americans. And would that be a bad thing? I think not.
Jeffrey PollackPhysician Mays Landing, N.J.