A small, but important addition to all the proposals in Congress
All the major proposals include what is called an "exchange" that will allow newly insured people to choose among a variety of health plans. In some proposals, one of these options is a public plan.
The exchange needs to be more than a "Yellow Pages" listing the plan options. Differences in premiums should reflect differences in efficiency, not the ability of some plans to attract low risk enrollees, or more problematically, to avoid the high risk people. Plans can easily do this by not offering the highest quality providers, the ones who will be most needed by the sickest people. Many proposals suggest that the exchange undertake "risk adjustment" to make the competition among plans fair.
After doing research in this area for over a quarter century, I am convinced the available risk adjustment tools are inadequate to do the job. This has led me to develop a proposal for a major risk pool that will address this risk selection problem and lay the basis for more fundamental delivery system reform.
To read more about this Major Risk Pool proposal, see:
Beyond the Public Plan: A Pathway to Contain Costs and Transform the Delivery System Berkeley Center on Health, Economic and Family Security
How to save health reform: A reinsurance plan that Democrats and Republicans should embrace--Reihan Salam in Forbes.com, September, 14, 2009