Boston Globe editorial: A public plan for healthcare

Globe Editorial

A public plan for healthcare

May 3, 2009

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The architects of reform in Massachusetts opted not to create such a public plan, and opponents of the idea, such as private insurance companies, make much of that decision. Private insurers fear that a public plan would use its bargaining heft to drive down costs and grab a disproportionate share of the market. Advocates of a public plan, such as President Obama, say it is the best way to ensure affordable coverage and to provide a yardstick for the private plans.

So, does the Massachusetts example clinch the case against a public plan? No.

As noted by speakers at a conference recently at Harvard's Kennedy School, this state could avoid a public option because it already had a highly regulated insurance system that ruled out some of the more unsavory features of laissez-faire private insurance. Companies in Massachusetts could not refuse customers because of preexisting conditions or reject policy renewals after health problems emerge. Insurers could charge higher premiums based on a customer's age or place of residence, but not health history.

The state required that insurers cover many treatments and procedures, such as special screening of newborns, beyond the bare-bones policies offered elsewhere. It had a relatively low number of uninsured residents to start with. And, almost alone among the states, Massachusetts had no for-profit firms among its major insurers.

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As the debate in Washington swirls over creation of a public plan, its supporters should not be cowed into dropping their insistence on it. Massachusetts is getting along without a public plan, but the national health insurance market is vastly different.