If Not the Public Option, Then What?

The public option is mostly dead. Is there another way liberal lawmakers could tweak health care reform to similarly lower the cost of health care for poorer Americans who would be forced to buy insurance? Yes, says Jonathan Cohn. Go Dutch, old men!


Netherlands manages to provide nearly universal, affordable and popular health care without an overweening government run program to negotiate down costs. How does it work? Like a public utility. The Dutch government basically regulates the bejeezus out of private insurance. No discriminating against pre-existing conditions. No higher premiums for more hazardous jobs. Minimum benefits packages must provide for chronic illness. To keep insurers from stockpiling healthy folks, the government actually taxes companies if their clients are too much healthier than the norm. There are also strong price controls.

Will Congress follow? Probably not. Of those five snapshots of Dutch regulation, the Senate plan lacks at least three: Insurers can still vary premiums by characteristics; nobody is talking about punishing companies for insuring healthy patients; and even the Dutch are moving away from strong price controls. Liberal reformers shouldn't despair -- a trillion-dollar health care bill is still very much alive -- but they shouldn't hold out too much hope for federal pressure to hold down prices.


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Derek Thompson is a senior editor at The Atlantic, where he writes about economics, labor markets, and the entertainment business.

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