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March 27, 2009

Perils of a Public Health Plan

By

There is a lot wrong with America's health system. People can lose their coverage if they switch jobs. Working families beset with chronic medical problems may be unable to get affordable coverage.

There is broad agreement - spanning both the liberal and conservative policy camps - on the need to fix these problems. But there's much disagreement on how to go about it. One great sticking point is whether or not to create a government-sponsored insurance plan.

The Obama administration is promoting that approach. The idea appeals to many Americans who have grown suspicious of private insurers. At the very least, they want to be sure there will be a "safe haven" insurance option, so that families can always be sure that they can get adequate and affordable coverage, no matter their health condition or employment situation.

The administration and others say a government-sponsored public plan can and should compete with private plans on a level playing field. With a public plan in place, they argue, Americans would always have a guaranteed last resort. People would know it would always deal with them fairly. And it would put pressure on private plans to keep costs in check and quality high.

The idea sounds attractive, but it is actually a bad idea. And federal lawmakers will find a far better alternative right under their collective nose.

In the public plan scenario, the federal government would create broad rules for the "game" in which plans would compete. But the government would not just be a neutral umpire in the game. It would also own one of the competing teams, namely the public plan.

Imagine the Washington Nationals made it to the World Series (I know! But just imagine it.) and were facing off against the New York Yankees. And imagine that in this series, the umpires were hired and paid by George Steinbrenner. Somehow I don't think anyone other than a few die-hard Yankees fans could claim with a straight face that we'd have a fair series on a level playing field.

After all, the series outcome would hinge entirely on his employees' decisions. And it would be King George's men who decide how to interpret the rules and make the call on whether the ball lands fair or foul, the pitch is a ball or a strike, the batter checked his swing, the throw beat the runner, etc.

It's equally impossible to believe that Congress and the administration could resist setting rules in a competitive health system - and interpreting those rules - so that their own public plan ended up winning the whole game. That's why many supporters of a single-payer system, where the government runs the whole health system, are suddenly converts to choice and private competition, as long as there is a public plan.

So is there an alternative to a public plan for addressing the concerns Americans have? As usual, it's always a good idea to look first at what members of Congress actually provide for themselves and several million other federal employees. That's the Federal Employee Health benefits (FEHB) program.

This year, the FEHB offers federal workers well over a dozen plans from eight different insurers. But not one of these options is a public plan. Why? Because Congress has rightly insisted that there must be a wall of separation between those who set the rules - the U.S. Office of Personnel Management - and those who offer plans.

The FEHB also demonstrates that you don't need a public plan to provide a "safe harbor" coverage option. The program has consistently offered several such options by negotiating with private plans to provide predictable coverage all over the country. These national plans include not just Blue Cross, but also several union-sponsored plans, such as the Mail Handlers Benefit Plan.

Rather than stack the deck with a public plan in a new health system, Congress could learn from the basic FEHB design, with its selected private plans acting as safe-harbor options.

This could be done several ways. It could arrange for states, using existing federal insurance regulation (the so-called "HIPAA" rules), to work with one or more private plans in the state to offer safe-harbor coverage through a high-risk pool or a similar mechanism.

If a state did not organize such a plan itself, then Congress could make the FEHB's national plans available to non-federal employees and their families in the state. These plans would be free of state benefit mandates and thus could provide coverage that is identical to federal employees. The federal government would operate a separate risk pool for these non-federal enrollees to avoid disrupting the FEHB itself.

Today there is a refreshing desire to find common ground in the health care debate. But the public plan proposal is fatally divisive. It threatens to explode any potential right-left coalition because it would push the country decisively towards a government-run system.

Americans do not want that. But fortunately, by looking first at its own health system, Congress can find a better way.

Stuart Butler is vice president for domestic policy issues for the Heritage Foundation.

First appeared in the Washington Times

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