NEJM Offers Perspectives on Public Plan

Three perspective pieces in the New England Journal of Medicine explore the merits and pitfalls surrounding a public health insurance plan or "public plan" for Americans under 65 who lack employment-base coverage that would compete with regulated private plans.

J.S. Hacker explores the value of a public plan to create health competition in Health Care 2009: Healthy Competition – The Why and How of "Public-Plan Choice. "The idea - largely ignored in 2008 when it was endorsed by then-presidential-candidate Barack Obama - has come to dominate an increasingly polarized national debate. This polarization is unfortunate, because public-plan choice can be made to work in a way that is effective, enduring, and acceptable to key stakeholders. Far from radical or unprecedented, it is based on established programs and models both here and abroad. And given that public-plan choice embodies values embraced by conservatives and liberals alike, it should not be a partisan deal breaker." Meanwhile, M.V. Pauly explores the value of choice and importance of options for different people in his piece Health Care 2009: Public Health Care and Health Insurance Reform - Varied Preferences, Varied Options. "Health care and health insurance reform will surely require a mixture of public and private efforts for different population groups in different settings. One feature that might help with the choices Americans make as consumers, voters, and taxpayers is a menu of insurance plans managed by both public and private organizations for all population groups. People will end up with insurance they like better and that works better for them if they can select a plan from a large variety of options." V.R. Fuchs argues that a public plan will not solve health care's major problems in Health Care 2009: The Proposed Government Health Insurance Company - No Substitute for Real Reform. "As pressure builds on the White House and Congress to deliver on their promise of health care reform, the idea of a government health insurance company to compete with for-profit and not-for-profit private companies is gaining political momentum. Advocates claim that this new company would be more efficient, honest, and successful in forcing lower reimbursement rates on physicians and hospitals. However, a close look at how the present health care system functions, what its major problems are, and what reforms are needed to solve them suggests that this new idea is not the answer" (5/28).