The Public Option and Real Health Reform

If you haven’t already, read Atul Gawande’s piece on health reform in the New Yorker, largely centered around McAllen, Texas, the community in America with the highest health care costs.

I agree with Gawande that we could end up with a public health insurance option that doesn’t foster the right incentives to control costs, and that wouldn’t be a big victory. But while Gawande is proposing some kind of outside board to control these incentives, I wonder if the public health insurance option isn’t the place where these reforms are put into action.

Think about it: One advantage to a public health insurance option is that it is transparent. Private insurance doesn’t tell you what they pay for services, how often these services are used, and whether these services have improved patient outcomes. A public health insurance option could make that data available and work with it to improve care and control costs. This data would put the public health insurance option in the perfect position to figure out why some places in America cost so much more and why their outcomes aren’t any better, and how to fix that.

We must get costs down, that much is clear. We need the tools to do it. I’m pretty convinced the public health insurance option can be at least a crucial part of that toolset.

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