Medical Device Daily

The realization of what some say is a much-needed revamp to the nation's healthcare policy could be just hovering on the horizon, but experts are chiming in to give their take on just what would be the most effective way in healthcare reform.

Last week, the Institute for America's Future (Washington) held a news conference to release details of a new report that gives a roadmap in creating a public health insurance plan within the nation's healthcare system.

"I'm arguing for a system where public, private plans can coexist side by side, so that everyone has access to healthcare," said Jacob Hacker, PhD, author of the study, titled "Healthy Competition: How to Structure Public Health Insurance Plan Choice to Ensure Risk-Sharing, Cost Control, and Quality Improvement."

Hacker joined Institute for America's Future co-director Roger Hickey at the news conference.

"Many studies have shown that a well-structured public insurance option will save the nation trillions of dollars over a decade," said Hickey. "This report kicks off the debate about how a well-structured public insurance plan would work."

Hacker's plan gives people without workplace coverage access to an "exchange" with private and public plan options. The public plan closely resembles that of Medicare's administrative infrastructure, but would be run separately from Medicare. The plan has its own risk pool and offers the same benefits and coverage terms nationwide.

"Without public plan choice, private health insurers will still be able to game the system to maximize their profits while failing to provide health security over the long run," said Hacker. "Providing a public health insurance option that competes fairly with private plans is critical to ensuring access, controlling costs and improving the quality of care for all Americans."

Hacker's report argues for a public health insurance plan with price-setting authority. It lays out safeguards to ensure its bargaining power is used correctly. These include an efficiency-based payment system (an improved version of Medicare's), an expanded Medicare Payment Advisory Commission, a stakeholder advisory group that includes providers and automatic triggers for case reviews.

The report goes on to say that to "create a level playing field requires attention to the three R's" of workable private competition: rules that are the same for both the public plan and private plans, risk adjustment that protects plans from being competitively disadvantaged if they enroll a less healthy group of people, and regional pricing that allows private plans and the public plan to compete within regions on the same terms, rather than having the public plan compete on a national basis with regionally based private plans."

Hacker said that giving the public plan the authority to bargain for reasonable rates is also a must for cost control. He added that there are concerns about how the new public plan will use its bargaining power.

Hacker also warned against a watered-down public plan and said that would be a "grave mistake."

Instead he opted for a public plan that would include safeguards designed to ensure that providers are fairly represented and that bargaining for lower prices does not negatively affect patients' access to care or shift costs onto private insurers.

Hacker and Hickey both stressed that a public plan choice is feasible, necessary, and desired by most Americans.

Speaking to legislators who had some objections about the plan, Hickey urged them to consider the cost of shooting such an idea down.

"Don't cut the heart out of President Obama's healthcare plan, which offers a choice for a public plan," Hickey said. "That's the basis of which he ran on."

Already more than 45 million Americans are uninsured. There are mounting fears that without affordable healthcare Americans without employer coverage will die from treatable diseases because they can't get good health care coverage.

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