Strong health care reform without a public option

Even if you assume the government could create and successfully implement a public plan, it would still be opposed by a sizeable minority of Americans. Factor in the likely side-effects of a public plan and how hard it would be to address issues as they occur, and it's easy to see why so many people are uneasy with it. All things being equal, private industry generally does a better job than the government, especially over long stretches of time.

However, being skeptical of a public plan is not the same as being against health-care reform. I am personally glad to see the administration signalling its understanding of this point and willingness to explore other options to achieve reform.

Instead of a public plan, consider the idea of goverment-drafted insurance plans fulfilled by private insurers. The goverment would draft coverage agreements at Bronze, Silver and Gold service levels which individuals could buy in the public market. This provides a selection for different income levels as well as confidence in what is covered and includes reform provisions such as requiring coverage of pre-existing conditions and wellness benefits. It would also reduce prices by making health insurance a commodity with robust competition.

Ideally these plans would be modeled on the HDHP/HSA model to return market economics to routine health care needs while protecting people finacially from catastrophic or chronic illness.

To expand coverage to more Americans subsidies could be used in the form of vouchers.

Goverment-sponsored research of best-practices (comparative effectiveness) as well as basic and applied research for expensive chronic conditions will provide information and new drugs to the system to reduce costs of covering customers on the government-sponsored plans.

This type of reform preserves the benefits of a free-market system with the consumer protections of a government-controlled system to ensure a fair marketplace while providing a framework for reducing costs, improving outcomes and increasing quality of care.