Cheat Sheet: The Public Plans

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On the stump in Wisconsin today, President Obama insisted that opposition to health care reform was based on fears that government would eventually run the system and reduce patient choice -- and that such a major transformation was not in the cards.  "I don't want government to run stuff," he said. 

He suggested that a government-administered health care plan would be a last resort for those who couldn't afford or did not want a plan offered by private insurance companies. Whatever plan passes Congress is likely to include a mandate for Americans to purchase health insurance.

For most advocates, the purpose of a public option is to create an "ideal" health insurance plan that can experiment, can decide to pay doctors what it wants, can use what Rep. Henry Waxman has called "creative tension" to compete with private plans, and one that will ultimately serve as a mean toward which all the private plans move. A strong public plan would force private plans to negotiate lower rates with doctors and hospitals, which would reduce health care costs. A "weak" public plan would provide some competitive pressure, but would not be big enough to force the private plans to drastically change their models. Between these two ends, there are many options. Here are six:

1. The Schumer Plan -- would be a government-run plan that follows the same rules that insurance companies do. It would pay for itself via fees. 


2. The Conrad Plan -- would be a series of health insurance cooperatives, administered privately but not for profit. Details remain vague. The federal government would not directly be involved. 

3. The Rockefeller Plan -- would be a conventional, government-run plan that pays for itself via premiums and fees.Reimbursement rates would be based on Medicare for two years (at least), which could, in theory, pressure private plans to lower costs. The plan would follow guidelines that a new health care trust would create. This trust would function as a marketplace, giving providers and patients a sense of what other plans are charging and how effective they are. This is the strongest public plan offered so far by Senators.

4. The HELP (Kennedy) Plan -- still in progress, an early version would require providers to participate, would pay them 10% more than Medicare, and would also expand Medicare and S-CHIP.

5. The House Plan: Medicare would be expanded and eligibility would be based on income alone. The government plan would be modeled after Medicare; to get providers on board, there would be some (potentially significant) reimbursement rate adjustments. 

6.  The Snowe Float: for a few years, the government would offer a conventional, non-competitive plan. If insurance companies failed to reform, to cut costs, to improve quality, a much stronger, competitive plan would be offered. This is what's known as a "trigger" plan. 
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Marc Ambinder is an Atlantic contributing editor. He is also a senior contributor at Defense One, a contributing editor at GQ, and a regular contributor at The Week.

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