Should a public plan option be part of any health reform initiative?

One of the most contentious health reform issues going forward is the possible inclusion of a public plan as one of the health insurance options patients can choose.

Progressives see this as a vital part of any reform initiative, but those on the right see it as a “backdoor” to a government-run, single-payer system.

I won’t hash out all the details here, instead, I’ll leave it to the many policy wonk blogs that debate the issue. The NY Times piece, linked above, has a nice summary of the arguments for and against.

I’m wary of expanding the role of Medicare, or any other public plan, since it will give the government more clout in fixing the prices of health services. Progressives say that’s precisely the point, but it’s a crude way to control costs, and does little to differentiate what primary care does, versus, say, the work of proceduralists.

On the other hand, I can also appreciate that, without competition from the government, private insurers will have little incentive to control spending.

That said, what’s absolutely non-negotiable is maintaining the ability for doctors to opt-out of any type of public plan. Doctors must not be coerced into accepting a public plan, like, for instance, a condition of receiving Medicare payments.

Health policy blogger Maggie Mahar says that, as long as doctors can opt out of the public plan option, the government will be forced to keep their physician payment rates competitive with those of private insurers (sorry, I can’t find her exact post where I read that).

For instance, if physician payments in the public plan are too low, we’ll have a Medicaid scenario, where the poor are “covered,” but since so few doctors accept their plan, it’s effectively rendered useless.

So, in the end, I’m indifferent to the inclusion of a public plan. What’s most important is that doctors must retain the right to drop Medicare, or its public plan equivalent, at any time.

Losing that ability will render the medical profession powerless against the government, who will use their clout to drive payments further down, with little recourse from doctors.