“Entry into the public plan for the eligible employed would be a two-stage process. First, employers would choose between paying into the exchange and buying insurance directly to cover their workers. Unless the exchange is such a good deal that nearly all employers take it, firms with a young, healthy work force would tend to buy insurance on their own, while those with higher-cost employees would go into the exchange’s pool. As a result, the pool would suffer “adverse selection” — it would get stuck with a higher-risk population.”
This is a crock. The largest group of uninsured Americans is between the ages of 18 and 24. If private insurance was already such a good deal for them, they’d have it. As it is, they don’t. All the public option has to do is offer a low enough rate to get those who don’t already have insurance on board, the highest risk population (the elderly and the disabled) are already covered by medicare.
Of course, the public option could be rendered completely inept if, say, stripped of the huge bargaining power afforded to it by virtue of being a government agency. There are lots of ways congress can screw this up, which is what I’m betting on. In the end, the American political system is only good at retarding sensible progress.
And in my mind, sensible progress means pretty much overhauling the entire system. The rest of the civilized world has already realized the need for much more stringent measures to control costs and insure people than would be considered here in only the most distant liberal fantasy-land. Hell, in Japan the cost of medical procedures are set, one by one, as a matter of policy. And of course, other countries have been more successful while we spend about 8 percent more of our GDP on healthcare than they do. That healthcare reform is intractable in this situation shows that it’s unlikely ever to happen.
