There’s an ongoing debate right now about having a government-run public health insurance option that would operate alongside the private health insurance industry. Howard Dean was here in Colorado last week, as part of his tour of the country to drum up support for this option. He has said that any health care reform that doesn’t involve a public option isn’t worth implementing. He’s pointed out that seniors age 65 and older already have a public option, and that the rest of us should too.
First of all, I think any reform would be better than none at all. There is no way that whatever happens with health care will please everyone. But that doesn’t mean that we shouldn’t try. Any strategies that decrease costs and increase realistic access to health care would be an improvement.
Then there’s the issue of Medicare. When Dean talks about seniors having a public option, it should be noted that for the vast majority of them, that is the only option. If they are retired and no longer eligible for employer-sponsored health insurance, there aren’t any other choices. Individual health insurance terminates when a member reaches 65, and isn’t available for new applicants who are 65 or older (in Colorado, some carriers won’t accept a new applicant who is nearing Medicare eligibility, even if they are still younger than 65). So we can’t really look at the Medicare population as an example of how the system would work if we had both a public and private health insurance option for all Americans.
If a public health insurance option were to become available, we don’t know yet how much it would cost in monthly premiums, or what percentage of Americans would make the switch to the public option. Part of the success of a system like Medicare has to be attributed to the fact that nearly the entire population over age 65 is enrolled (and thus costs are spread across large numbers of both sick and healthy people). With a public option for younger Americans operating along side private health insurance, would a disproportionate number of sick people join the public system? Or perhaps more healthy people would switch to the public option? Would the premiums increase substantially over the first few years as the new system tried to balance costs? Would people be able to switch back and forth between the public and private systems? A lot remains to be seen. I believe that it could work, but I don’t think that Medicare can realistically be used as a model for how it might work.