The Other Side

So, here is a link to The Agenda's argument against the public option. It's probably the most concisely argued view from the other side that I've read.

Basically what Salam is arguing is that there are three paths...

* Public Plan with Medicare Payment Rates. This path includes a public health insurance plan that pays providers at Medicare rates and is offered alongside private plans within a national health insurance exchange.
* Public Plan with Intermediate Payment Rates. This path includes a public insurance plan that pays providers at rates set midway between current Medicare and private plan rates and is offered alongside private plans in a national health insurance exchange—and subject to the same market rules as they are.
* Private Plans. This path does not include a public plan option; it includes only private plans offered to employers and individuals through a national health insurance exchange.

All three offer savings. Over ten years they save, respectively, $3B, $2B, and $1B.

If one or two happens then providers (doctors, hospitals, etc.) will engage in cost-shifting, where they make up for the lack of cash from the public option by charging more money to the private insurers. This will lead to higher co-pays, deductibles, etc. and will lead to a single-payer system, and that's just bad (doesn't say why, but medical innovation and wait times will probably top the list).

Salam does end on a slightly anemic note, but does say that we can save money by creating more efficient provider networks. Which is true. Places like Mayo and Cleveland have a much more efficient system, and that's partly because they don't engage in fee-for-service pricing. Which is why the reform package pushes for 'bundling' payments!