Last night Atrios said that without a public plan “there really isn’t much point to any of this. The public plan is the point.”
I think that’s wildly overstating the case. There are several different aspects of these health reform proposals and they’re all important on their own terms. Most notably, the design of the terms of new health insurance “exchanges” on which individuals and small businesses will be supposed to buy health insurance is extremely important. Appropriate regulations could make these sort of exchanges really work for people. And if we had a functioning individual health insurance market, then that would set us up down the road for breaking the link between employment and health insurance. A big part of what makes the public plan issue important is that I think including a robust public option in the exchanges would do a lot to help make them work well. But obviously the regulatory rules governing the exchanges are also a big deal on their own terms.
There’s also what you might call “the other public plan,” the proposals to expand eligibility for Medicaid. Medicaid’s not the greatest program on earth, but it’s a lot better than having no health insurance at all. And while haggling over exactly how much Medicaid should be expanded hasn’t yet captured the imaginations of the blogosphere, the extent to which the program is expanded will make a huge difference in the lives of the directly affected families. Then there are subsidy rate issues, and the whole question of putting tougher regulations on insurers regarding pre-existing conditions and price discrimination.
We shouldn’t let politicians off the hook on the public option, but we shouldn’t let them off the hook on everything else either. The health care sector is giant, so naturally a proposal for comprehensive reform winds up having a bunch of different components that are all important.