Healthcare for Dunces by Gabriel Winant

[Better Believe It]

Healthcare for dunces
Don't know your "single-payer" from the "trigger plan"? As Senate hearings begin, we explain the basics
By Gabriel Winant
Salon.com
July 13, 2009

The public option: In order to capture some of the benefits of single-payer while dodging the political costs, liberal would-be reformers have mainly settled on what's known as "the public option" idea. At its strongest, this would work as a kind of opt-in Medicare for All. It could pay at Medicare's rates and, like Medicare, deliver much more care for the dollar. Usually, this idea is coupled with a mandate that everyone have insurance of some kind (and subsidies for people at a certain level of poverty), so the government could offer insurance directly to people who don't like their plan, or don't have a plan at all, without incurring the wrath of voters happy with their insurance. One prominent scholar warns, though, that a public plan might become a dumping ground for the sick, while the private insurers skim the cream off the system by only having to insure the healthy.

A public option also has the benefit of forcing private insurers to compete with Medicare-level rates. This would either improve private care significantly, the logic goes, or possibly kill it outright if it can't compete for insurance-buyers, easing the country into single-payer gradually and of its own will.

That's why insurance companies are putting aside their differences to try to throttle this thing before it gets off the ground. Or at least soften it acceptably. A number of compromise-minded pundits and politicians have suggested that a public option is only tolerable if it can't use Medicare's heft to keep prices low, or rely on government subsidies to break even. A weak public plan like this would be mostly toothless -- basically, a kinder, friendlier insurance company -- and hence much less threatening to private insurance.

The trigger plan: Some have proposed kicking the can down the road on a public plan, by writing the law without it, but including the threat that private insurers will "trigger" a public plan into being if they fail to quit their lowdown ways. If insurance companies were, for example, underserving or overcharging a particular region, the government might then offer that region a public plan. Note that a similar possibility for triggering a public plan was built into the 2003 Medicare Part D bill. Congress never pulled the trigger.

The co-op plan: Senate Budget Committee Chairman Kent Conrad, a North Dakota Democrat, has floated this compromise idea.
Conrad's co-ops would be seeded with federal money, and would follow the model, roughly, of credit unions. Owned by their members and functioning as nonprofits, they would allow people to pool their purchasing power to negotiate for cheaper care. Critics say co-ops would take years or even decades to get off the ground, and question if they would really lower costs significantly at all. A working health co-op called Group Health in Washington state, for example, has premiums similar to those of for-profit insurers, though it has been less ruthless about purging sick members.

Please read the complete article at:

http://www.salon.com/news/feature/2009/07/13/healthcare_explainer/