Where The Health Care Debate Is Going

The following was written by Campaign for America's Future Co-Director Roger Hickey and Online Editor Bill Scher

The health care debate has leapt forward in the last few weeks. After the bold health care plan from John Edwards [1], and the new business-labor coalition Better Health Care Together [2]-- spearheaded by Andy Stern (founder of Wal-Mart Watch) and the CEO of Wal-Mart, Lee Scott-- there is a growing consensus. America needs, and Americans want, heath care for everyone in America.

It is terribly significant that we are forging a broad consensus that everyone should be covered. Now the debate shifts to the question of how to get there.

Long-time advocates of universal health care are properly suspicious of plans that get the label right but the details wrong. If something called "universal health care" is a big flop, conservative forces will crow heartily, a scarred public may become too cynical to try major reform again, and too many Americans will remain uninsured and underinsured.

Massachusetts' new program and California's proposed plan did get it wrong. Under the "universal health care" label, they merely subsidize inefficient private insurers with taxpayer dollars. They may nominally cover everyone, but without cost savings for consumers, the middle-class and the poor will continue to be squeezed. So what's the point?

Does John Edwards' plan suffer from the same flaw? Some advocates for "single-payer" -- essentially expanding Medicare to cover everyone -- are raising questions [3] because it doesn't immediately put private insurers, and all of that wasteful redundant overhead, out of business.

But Edwards' plan -- which draws from Jacob Hacker's "Health Care for America" [4] proposal -- offers something that Governors Mitt Romney and Arnold Schwarzenegger did not. A new public plan for Americans under 65, complementing Medicare, that would compete with private plans.

Some remain understandably skeptical. For example, who cares if there's a public option, if private insurers can make a mint cherry-picking healthier young adults, burdening our government with the expensive cases? That might nominally cover everyone, but at excessive cost on everyone.

Here's where the details matter. If the rules set a fair playing field, and ensure a floor of quality coverage, then we'll get a win-win scenario.

One possibility: the public plan will attract the most Americans, win the competition against private insurers, and our system will naturally evolve into single-payer. (Edwards himself considers this a possibility.)

Or, because the floor prevents a race to the bottom, the public-private competition raises the bar on care and efficiency, improving quality and cutting costs, even in the private insurance plans.

Either scenario is a win substantively and politically. All Americans get good coverage. And we further prove that our government has a critical role in building a vibrant economy that works for all.

But if the rules for public-private competition are poorly thought out, an inefficient private system will simply suck subsidies from the public sector, sullying the promise of universal coverage.

Again, the details matter. The initial Edwards plan has room to add in crucial details. And Hacker is urging Edwards to enhance his proposal by ensuring the public plan would "offer the broader benefits necessary to attract younger workers and compete on a level playing field with private insurance plans."

And other presidential candidates have a choice: they can learn from Hacker and compete with Edwards to outline a serious public-private plan for covering everyone – or they can chose to give away our future to the private insurance industry, and suffer by comparison during this year of public comparison and issues debate. (Barack Obama has pledged to have a comprehensive health care plan on the table in the next couple of months, and Hillary Clinton and the other candidates will have to do the same.)

As the debate moves forward, let's do our best to keep our focus.

We have a consensus on achieving "universal health care." We know that the private market has failed in meeting that goal. We know that our government has a positive role to play. How we best direct our government to effectively serve our health care needs, that's the debate.