Jacob Hackers recent comments in the New England Journal of Medicine on what is now called the public option plan are exactly right.
But the notion of public and private health insurers working side by side is not new. Similar models have existed for decades in Europe and the countries of the Pacific Rim. They are in reality public-private options. They represent not so much a compromise position for competing interests as a new contract, a new partnership and a new opportunity for meaningful choice. Furthermore they provide universal enrollment, produce health outcomes as good as or better than the U.S., and contain costsoften at levels of per capita health spending that are half the cost in the U.S.
Dr. Hacker is also correct when he states that this proposal should actually allay the polar partisan concerns at both ends of the reform debate spectrum. Single-payer advocates, some of whom express such visceral disdain for anything remotely supportive of the private health insurance industry, are beginning to sound like children who will take their toys and go home if they cannot destroy the private health insurance industry. Instead, they should be looking to strengthen the public option when it finally becomes part of the American landscape, which it will.
Private insurers provide advantages that public plans cannot provide. Even cursory reading of the healthcare reform efforts among nations whose healthcare systems already implement a public plan option reveals the undeniable success of private health insurance plans. Private plans are much more responsive to patient utilization patterns; they provide care alternatives that the public plans simply do not, or cannot, provide. In fact, the private health insurance industries of these nations continue to thrive while reform efforts work to help their public plans keep up. (In the meantime, Canadian reformers clamor for the equivalent of a private plan choice. Theyd like to have private health insurance available.)
This brings us to the folks at the other end of the reform debate spectrum: the insurers. These folks are crying wolf, complaining that a public option will be some kind of Trojan horse.
They wring their hands that a public option will be the death knell of their precious health insurance careers. Nothing could be further from the truth. Internationally, private health insurers are prospering. Why? Because they outperform government bureaucracies every time.
A level playing field may be difficult to come by, but the expressed concerns of the U.S. private health insurance industry are false. No country with the equivalent of a public option plan has ever crowded out its private health insurance industryever. The public plan option needs as much protection as do private insurers, perhaps more.
Selvoy M. FillerupMember Board of directors Center for Health Care Policy Research and Analysis Merrick, N.Y.