Until now, the Left has largely used the public plan as a way to sell the Obama/Clinton/Edwards health care plans to itself. In this telling, the public plan is a Trojan horse for single-payer health care. When socialism comes to this country, it will be wrapped in the rhetoric of competition. That may prove to be true and it may not. But it's not going to fly in the Senate. Blue dogs don't vote for socialism (except, as we saw in the case of TARP, when they do).Jacob Hacker, working through the Campaign for America's Future, recently released a brief (pdf) making a different argument: The competitive pressure offered by a public plan is essential for the effectiveness of private insurance. If a private system is to work, says Hacker, it will need a public plan.This is an altogether more interesting and audacious approach, and Hacker justifies it with three arguments. First, "that public insurance has a better track record than private insurance when it comes to reining in costs." Readers of this blog know all that. If you didn't, here's a graph. You know how I love graphs:
The second argument is more novel: A public plan, says Hacker, is "a prerequisite for substantially improving the quality and effectiveness of American medical care." Private insurers keep their claims and effectiveness data proprietary. They argue that the data amounts to a trade secret: It is what they use to glean analytical insights and better their product. Releasing it would deprive them of competitive advantage. Medicare, conversely, shares its records, and they've been responsible for some of the most important health policy insights in recent years. The Dartmouth Atlas findings that more specialists mean more care but not better health -- an insight that has revolutionized how we think about health reform -- came from Medicare payment data. Medicare is also the most common site for most delivery reform analysis. This is not because they're the only ones who innovate, but because they're the only ones who will allow researchers to study the outcome of those innovations. The Medicare disease management pilot, for instance, was a failure. That was an important lesson. But we'd have never known that if the test had been carried out be Aetna. Aetna, after all, doesn't want to be associated with failure.
The second argument is more novel: A public plan, says Hacker, is "a prerequisite for substantially improving the quality and effectiveness of American medical care." Private insurers keep their claims and effectiveness data proprietary. They argue that the data amounts to a trade secret: It is what they use to glean analytical insights and better their product. Releasing it would deprive them of competitive advantage. Medicare, conversely, shares its records, and they've been responsible for some of the most important health policy insights in recent years. The Dartmouth Atlas findings that more specialists mean more care but not better health -- an insight that has revolutionized how we think about health reform -- came from Medicare payment data. Medicare is also the most common site for most delivery reform analysis. This is not because they're the only ones who innovate, but because they're the only ones who will allow researchers to study the outcome of those innovations. The Medicare disease management pilot, for instance, was a failure. That was an important lesson. But we'd have never known that if the test had been carried out be Aetna. Aetna, after all, doesn't want to be associated with failure. 
