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Getting to a Single-Payer System Using Market Forces: The CHOICE Program
Abstract
The CHOICE program is a new approach to health care reform that very quickly achieves nearly universal access to a single-payer health insurance system for all U.S. residents without any individual mandates or new regulations for employers or health insurers. It accomplishes this goal by offering all U.S. residents a new choice for their health insur- ance coverage that better meets their prefer- ences as health care consumers, providers and employers. CHOICE offers Americans the op- tion of unrestricted access to nearly all li- censed health care professionals and facilities in their state for comprehensive, affordable, high-quality health care without eliminating any of their current health insurance options. The simple beauty of the CHOICE program is that it achieves these goals through economic incentives, competition with the existing sys- tem, and ultimately transitioning the entire system as a result of the voluntary choices of individuals, businesses, and health care pro- viders. The result is increased access, equity, efficiency, choice, and security for all. CHOICE is a shared responsibility between the federal and state governments, with states having flexibility in how they design and ad- minister their programs. CHOICE recognizes the differences in the public programs and de- livery systems operating within each state, as well as the varying needs of their populations, and gives states the opportunity to tailor their programs within federal guidelines. Financing is a mix of public and private, and each state contracts directly with private and public health care providers and organized delivery systems in the state to provide covered health care services. All U.S. residents who enroll in CHOICE will have two major options for af- fordable, comprehensive health insurance
... In 2003, CHOICE in California served as the basis for a national reform proposal published in the Robert Wood Johnson Foundation's Covering America Series, "Getting to a Single Payer System Using Market Forces: The CHOICE Program." 5 The national CHOICE proposal gave each state responsibility for administering a new insurance exchange, contracting with managed care plans, and creating and administering a new public plan. However, the CHOICE proposal was not immediately embraced at the state or federal level, and it would not reemerge until the 2008 presidential campaign. ...
... Use Of Medicare Rates The Medicare-like approach would have tied payments to Medicare reimbursement, with proposals for using 100 percent or more of Medicare rates. 5,8,25 Those who supported using Medicare rates focused on the potential to lower costs. Opponents, on the other hand, were concerned about unintended consequences. ...
... 24 They were also concerned that states would have no control over how the insurance exchange and public option were designed, and they argued that each state or region was best positioned to meet the needs of its constituents and design the options to fit its market. 5 Eligibility Another design issue concerned eligibility for the exchange. The more people who were eligible to purchase in the exchange, the larger the risk pool would be, and the greater What progressives saw as the benefits of a public option, conservatives saw as its flaws. ...
The "public option" for health insurance, as defined by the 111th Congress, grew from roots planted in California in 2001. Progressives supported it as a voluntary transition toward single-payer insurance, while conservatives opposed it as a government "takeover" of health care. Although present in several interim bills and in legislation passed in November 2009 by the House of Representatives, the public option was omitted from the legislation passed by the Senate in December 2009 and from the final package adopted by both houses in March 2010. Lack of support among moderate Democrats, opposition from Republicans, and ambiguous messages from the White House are among the explanations for the public option's defeat. However, there is nothing in the recently enacted legislation that would prohibit states from creating a public option in their exchanges.
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