Experts have considered various approaches to implementing a public health insurance program to ensure fair competition and quality of care. Many questions remain unanswered, in particular, would a public insurance plan be administered by state governments or by the federal government?

In recent years, there has been increasing buzz around the idea of a publically-sponsored health plan; shifting the traditional notion that health care is a privilege to health care is a right. Kaiser Family Foundation aired a topical webcast entitled, A Public Plan Option under Health Reform, featuring three experts discussing various approaches and implications of a publically-sponsored health plan. In particular, Jacob Hacker, Ph.D., and Stuart Butler, Ph.D., specifically debated whether the federal government or state governments should be charged with the task.

Stuart Butler indicated a preference for state level implementation, pilot testing and experimentation. He noted that there is not enough evidence of information to implement a national system, but that he wouldn't rule out moving towards one in the future. In contrast, Jacob Hacker indicated he favors a national framework; since this is a national problem it should be addressed on a national level with appropriate regional variations and regulations. Mr. Hacker does not believe that states would effectively administer a public insurance program due to special restrictions, regulations and budget deficits. Further, he noted the potential for major variations in state programs which could be problematic and potentially drive people to move to a state with a better program.

All three panelists highlighted the importance of fair competition and advocated three plans operating simultaneously--private insurance, a public program and employer-sponsored. Further, Medicare was exemplified for its efficiencies and low administrative costs. While the experts mentioned a potential expansion of the program they did emphasize that a publically-sponsored health plan would be a separate entity.