The Center for American Progress, admittedly a liberal think tank, has some great thoughts on how we combine public and private to build a health care system that works.
What most of us think when we debate the issue is about what's wrong with each one. What's real is that we already have government involvement, and there are strengths. There also are strengths in private industry. The so-called free market isn't the answer.
The answer lies in a working partnership:
If It Ain’t Broke, Use It: Expanding Public Programs in Health ReformPublic health insurance programs—notably Medicare, Medicaid, and the State Children’s Health Insurance Program—have evolved to insure people with the greatest health needs or the least resources. These programs cover one out of every four Americans, including the elderly and the disabled under Medicare; low-income families, the elderly, and the disabled under Medicaid; and low-income children and parents under SCHIP. The federal government also provides health benefits to federal employees, American Indians and Alaska Natives, military personnel, and veterans, while state and local government manage health benefit programs for their employees and some low-income populations.
Despite their proven success, some question what role, if any, public programs should play in a reformed health system. Some believe that public programs have no role in health reform. They argue that private insurance and market forces will ensure seamless, affordable, and quality health coverage. Others see the flaws in public programs and would choose to eliminate them altogether rather than improve them as part of a broader reform effort. In contrast, advocates for public program expansions argue that there are inherent limitations to private coverage, and that reform should focus on expanding public programs to ensure that all working families have health coverage that meets their needs.
The line between public and private coverage has blurred in recent years. Medicare, Medicaid, and SCHIP all use private health plans to cover at least some of their enrollees. While the federal government funds approximately 75 percent
of the health care premiums for its employees through the Federal Employees Health Benefits Program, it contracts with private insurers to provide the coverage.
Despite the complex and overlapping roles public and private payers play in our health insurance system, rhetoric in the health care reform debate suggests stark divisions. Conservatives demonize the role of public coverage while emphasizing the sanctity of private coverage, while progressives have accused private insurers of seeking profit at the expense of care and, sometimes, lives.
Reviewing the success of public programs will be critical to the growing discussion about health care reform. This does not mean that public programs are perfect. Medicaid, for example, must be transformed and strengthened in several areas, including by ensuring enrollees access to providers and specialists. Medicare faces significant controversy around its provider reimbursement rates and Part D payment rates. And SCHIP could use a more equitable formula for dispersing federal funds to the states.
In health reform, we now have a vital opportunity to capitalize on what works and improve what does not in public programs. The achievements of private insurance should also be considered and incorporated into any effort to transform the system. As Jeanne Lambrew, the new deputy director of the White House Office of Health Reform explains,
"The question is not whether or not there should be a public plan role in health reform, but instead what balance of public and private plans best moves the system toward affordable quality coverage for all.”