The goal is to provide competition for insurance companies to force them to find ways to reduce premiums and cut costs. Currently
a single health insurance company controls more than half the market in at least 21 states; two companies control more than half the market in at least 39. No wonder Kent Conrad, in whose state
Blue Cross - Blue Shield controls 90 percent of the market, is opposed to the public option.
But why is the insurance industry so uncompetitive? In part it's because of state regulations restricting the types of policies that can be sold. One of John McCain's proposals last fall was to eliminate these restrictions and free up the health insurance market. Auto insurance can be sold across state lines, why not health insurance?
Would this proposal increase competition? I don't know. Democrats scoffed at the proposal, but I don't recall hearing a counterargument. Someone somewhere, I believe, wrote something about how this would create a "race to the bottom" in the health insurance market, but I don't know exactly why that would be the case. At any rate, if the government were to impose some requirements on insurance coverage at a national level it would prevent any kind of race to the bottom. It sounds like such national standards are part of the various bills under consideration. I don't know what the hell these "exchanges" are all about, but that too sounds like a way to create a competitive market in a standardized product. Prohibiting companies from denying coverage to people with pre-existing conditions would also force competition by price rather than by cherry-picker.
Another potential problem with eliminating restrictions on cross-state insurance is that it would accelerate consolidation in the health insurance industry.
Cody Willard at MarketWatch says companies like BCBS, Wellpoint, and United Health are gobbling up independent insurers at a frightening pace, in the process becoming lobbying giants that deploy their resources to prevent reform. (Wait a minute, can I trust anything written by a guy named Cody?) He proposes applying anti-trust laws to the insurance industry, from which for some reason the companies are exempt. That too sounds like a no-brainer.
So couldn't some combination of exchanges, cross-state competition, national standards, strict regulation, and anti-trust actions perform the same purpose as a public plan? I think so.
Here's a sensible proposal along those lines.
Much as a public plan makes sense to me, it doesn't have enough support even among Democrats to pass the Senate and the public isn't wild about it (perhaps because they're idiots, but nevertheless...). If it's not necessary, drop it, compensate with strong regulation, and declare victory. Also, as I understand it, there's nothing stopping a state or a group of states from getting together to offer a public insurance plan. Advocates of single-payer and its ilk can work for this once the basic framework of universal coverage in a competitive market is in place.