It looks like "the public option"...

...could be the major point of contention in health care reform this year. A New York Times editorial today says that:

The insurance industry is so desperate to avoid competition that it has already pledged numerous reforms and called for tighter regulation of the private market to expand coverage and control costs. But even with tighter regulation, Congress should include a public plan option to give consumers broader choice, provide a refuge for people who don’t trust private insurers to have their best interest at heart and serve as a yardstick for judging the performance of private plans.

Private plans have done a poor job at restraining premium increases; they mostly pass rising medical costs on to the subscriber. A good dose of competition from a public plan with potentially lower administrative costs and no need to generate profits might be the right competitive medicine to improve their performance.

If you've worked for large companies for most of your career you're probably happy with the health insurance you've had. After all, private insurers have an incentive to keep large customers happy. But if you've ever been self-employed and had to deal with a private insurer directly, you begin to see the inherent conflict that this excerpt describes. Remember, insurance companies are in business to collect premiums and avoid paying claims. That's their business model. And individuals have very little leverage with a large company. Your business is just as much a nuisance to them as anything. A public plan, without the incentive to maximize profits, might just be a better option for the consumer. (There was a time not too long ago that I thought I'd never write a sentence like that. But as Colin Powell, a Republican, said recently, "Americans are looking for more government in their life, not less." I guess the pendulum has swung.)

Now the editors at The Wall Street Journal would like to have it both ways. On the one hand, they are fond of reminding their readers, again and again, how inefficient government is at running things and what a disaster it would be to let them run health care. (I actually think the Post Office does a good job; try getting FedEx to mail a letter for 44 cents.) But the government isn't seeking to run health care; the public plan would be an option. In the next breath, The Journal says that private insurers could never compete with such a plan. Why? Is that because a public plan would be, gulp, better? So which is it, WSJ? Would a public plan be inefficient or more efficient?

The bottom line here is that if you will always be employed at a large company you will never have to worry. You will always have first-rate coverage. But that's a big assumption nowadays. If you ever find yourself out of work or would ever like to go into business for yourself, just don't do it when you're too young for Medicare or if you have any pre-existing conditions, because you might find yourself without insurance. I, for one, am self-employed, healthy, and have a private policy. But I'm the exception, not the rule. And my luck could change tomorrow--so could yours. Simply put, my experience with the private insurers has been an eye-opener. I've learned that their interests are often at odds with the patients and doctors. So I wonder if a public plan could serve the consumer better. I'd certainly be willing to give it a try.