Monday, October 26, 2009

On The Public Option

I have not written much about the public option in the health care reform debate, mostly because discussing a formless ghost is pretty pointless, and a formless ghost is what the public option has been so far. Until we know who is allowed to join it and under what conditions we can't really tell what its effects would be on access or the costs of health care or the general competition in health insurance markets.

Now Harry Reid has brought out a Senate version which includes a public option with a right for individual states to opt out of it. I'm not sure how that would work in detail and those details do matter. But I can already imagine the pressure the individual insurance industry would put on states to opt out. It also looks to me as if the states most likely to opt out right now are the ones with the most uninsured, and that would be pretty bad. On the other hand, no state has opted out of Medicaid, so perhaps no state would ultimately opt out of the public option, either.