An excellent point from Igor Volsky who observes that the idea of cutting health care costs through a beefed-up MedPAC is highly complementary with the idea for a robust public option for non-seniors:
This makes the public plan all the more important. If MedPAC is identifying payment reforms that would lower health care spending, then the public health option could transfer those methods into the private insurance market by itself adopting these efficiencies and (through the miracle of competition) coax private insurers to do the same.
One might add, conversely, that public-private competition among non-seniors could also act as a check against the (in my mind, remote) threat of MedPAC decision-making run amok. But the broader point is simpler. Clearly, everyone working on health reform sees that senior citizens should have a publicly run insurance option—it’s called Medicare. Equally clearly, everyone is hoping on reforms implemented through the Medicare process to pay systematic dividends in terms of ensuring the availability of affordable coverage for everyone. The logic of those two points is firmly in the direction of a serious public option for the under-65 crowd. The transmission of Medicare-based reforms throughout the system could happen without such an option, but it would be much easier to make it happen with a public option in place. Politics is politics, of course, but if Medicare is the right option for senior citizens and if Medicare is an important mechanism for influencing provider behavior, it continues to be hard to see the case on the merits for denying a Medicare-esque option to the rest of us.