Professor Jacob Hacker originally defined the concept of an ideal 'public option' as part of health care reform a decade ago. He evaluates current health care proposals in his recent report Public Plan Choice in Congressional Health Plans: the Good, the Not-so-good, and the Ugly. On page 20 Hacker includes a chart comparing 4 of the current federal proposals based on 5 criteria against his definition of the ideal public plan.

Hacker writes, "The simplest public option is to let people without employer-provided health insurance to buy into Medicare, or a similar program, at cost."

Democrats started with a compromise position, failing to make the best case for health care reform as key to economic recovery -- a single public-payer model with full choice of private providers (unlike private insurances that limit provider access). Instead, Democrats have promoted a largely undefined 'public option,' and permitted the political right to define the terms of the debate using distortion and distraction.

As Hacker notes, a strong public plan at the very least must be built on Medicare's existing provider network and payment methods, and not weakened by requiring the plan to create a provider network from scratch, or to negotiate rates individually with each provider across the nation. Access to a 'public plan' should not be restricted to only the smallest firms.

The best way for President Obama and Democrats to reclaim the issue is by making their 'public option' an optional Medicare buy-in for anyone. Medicare is known and liked by most people, and not so easily distorted. Medicare has low overhead costs for built-in cost containment, and its structure is in place -- it could be up and running relatively quickly, with no need to create a whole new program at additional cost. Enlarging Medicare's risk pool by permitting younger people to buy in on a sliding scale would improve its financial stability.

Additional improvements to Medicare would encompass eliminating costly high subsidies to privatized Medicare Advantage plans, and permitting negotiation of drug prices as is done in other countries, while improving provider reimbursement. See also: 'Public Option' a Shadow of Its Original Intent - Dr. Marcia Angell Advises Optional Medicare Buy-In

STATE & LOCAL SAVINGS WITH SINGLE PAYER
Share with legislators the 6-page Summary of State and Local Savings of Single Payer in the 2007 Lewin Report as a remedy to strained local and state budgets. Some public policy people are beginning to consider these savings as states become more distressed.

NUMBERS OF UNINSURED AND UNDERINSURED IN COLORADO
A Denver Post editorial recently repeated the error of attributing all unpaid medical bills to the uninsured. "If we only insure the uninsured, runs the thinking, cost-shifting in the form of rising premiums for the insured will be ended" -- completely ignoring the link between growing numbers of underinsured and the increased unpaid medical costs over the past decade.

In addition to denial or delay of care, insurance companies make money by shifting more costs to families and individuals by moving them to "catastrophic" or "consumer-driven" health plans with less coverage and high out-of-pocket costs.

A 2008 Study  by doctors at the University of Colorado School of Medicine revealed that of those with insurance for a full year, <b>36.3% were underinsured</b> -- that is, they reported the delay or omission of recommended care because of their inability to afford it; half felt that their health suffered because they could not afford recommended care.

A 2009 Study by Families USA reported that <b>32.4% of Coloradans were uninsured</b> - nearly 1 out of 3 people under age 65 had no health insurance all or part of the 2-year period 2007-2008. 

Combined, the numbers indicate that at any point in time, as many as 68.5% of Coloradans may be under- or uninsured.

RESOLUTIONS IN SUPPORT OF SINGLE PAYER
Denver Democrats Executive Committee voted 44-4 for a resolution urging our state and federal legislators to support single payer health care reform. Read about it . Other Colorado county Democrats have also expressed support of a single-payer system, including Montrose, Boulder, Costilla, Hinsdale, La Plata, Arapahoe counties, and recently Jeffco. The nation's mayors passed a Resolution in support of single payer, HR 676, at their gathering last summer.