Include a public-health insurance option

Creation of a public-health-insurance option is central to the health-care reform debate underway in Congress.

Consumers need a competitive choice that is affordable, portable and fairly priced. Employers want relief from soaring insurance premiums.

The outlines of a federal plan are taking shape, and it has political traction because Americans are overwhelmingly in favor of a government option. A New York Times/CBS New Polls found 72 percent of respondents willing to support a federal plan that looks like Medicare for all. The poll also found a willingness to pay higher taxes so everyone was covered.

The country has been through this discussion before, but the need and frustration has reached a point where change can happen.

Separate plans are percolating through the House and Senate, and the public must be provided a lot more information. The cost to the public treasury is sobering — estimates as high as $1.6 trillion over 10 years. Expensive, but no one defends the ballooning costs of the current system.

Spreading the expense and maximizing coverage points toward individual and employer mandates, that require all citizens to have health insurance and all employers to provide it or a pay fee, perhaps 8 percent of payroll. Exemptions for small employers are predictable.

Insurers could not deny coverage for pre-existing conditions or raise premiums for those who are ill. Any public-insurance option would likely offer three or four plans with different benefits.

The availability of a public-health-insurance option is seen as a key driver of change within the private insurance market. Genuine competition for existing products.

The oft-repeated elements of slowing health costs are still in play: an emphasis on preventive care, Medicare savings, electronic-medical records and rewards for best practices and healthy outcomes.

The successful formula is likely to be a combination of cuts in spending and raising taxes, all with an eye toward providing health insurance for all.

After so many false starts and clever ads from opponents of health-care reform, the public is serious about change. Politicians notice.

Offering a public-health-insurance plan in the mix of reforms represents an infusion of competition to help spark results.