This week, Obama signaled that he might be open to doing away with the 'public' health plan option. I applaud that. While Obama said that the public plan was/is but "one small piece" of the puzzle, while that may be true as far as the overall idea for reform goes, that is not true as far as cost. The plans in the House etc. that include a public option are costly by CBO estimates in large part due to a new public health option and the bureaucracy around it.
Of all the plans out there, I like parts of the bi-partisan Wyden-Bennett plan.
One of the big benefits of such a plan is that it encourages private competition, creates federal oversight, but would also create State-run collectives - all insurance would be purchased in a State pool, as opposed to at the individual consumer level.
I like all but the last component. While the cost to the Federal government may be low, the cost to States, and the varying ways that States could administer the pools, makes this problematic. We don't want States competing with each other on health pools.
I think there is a way we can keep the 'pool' idea but still allow individuals to make their own choices (at maximum competition - across State lines and providers etc). One way would be to, instead of creating a State-run pool, create a Federal run set of pools - but that would undoubtedly cost a lot
A better option would be to take the government involvement and oversight ideas of Wyden-Bennett and merge it with Sen. Baucas's plan for a Non-profit Co-op. So, instead of pooling individuals by geography, people would be pooled nationally by the co-ops. Customers wouldn't chose their health plan - the co-ops would negotiate rates in the private market. But customers would instead choose what co-op they would be part of. The 'Wyden' part of this comes in so far as the Feds (or States) would then regulate a set of websites that provide information about all the various co-ops nationally (on price and history of service etc). It's the best of both worlds - competition amongst insurance groups due to the Co-op, and competition amongst co-ops due to the pool - all while eliminating potentially harmful competition amongst State governments.
So how should this be structured?
One way would be for the government to run the co-op site, but that could be costly. A better way would be for, in addition to the Feds providing 'seed' money for co-op formation, it would provide 'seed' money to companies like priceline.com, orbitz.com which already have infrastructure and knowledge in place to run sites that can show customers the best deals (quality and price). Only, instead of planes and hotels, they would be 'selling' information about the best co-op plans available. The government would of course need to provide oversight to not just the co-ops but also these health information databases - but the cost would be much smaller than the government actually 'running' these programs.