To see a public option as a step to single-payer nationalized health care, you have to believe that . . . it will be so attractive to the majority of the American people that they will be moved to take the next step. I guess the far right believes it is that attractive — but personally, i can’t see it.

When taxpayer money can be used to subsidize the premiums of those who sign up for the public option, and the government continues to restrict access to private insurance except those plans deemed acceptable by state regulators (with the public option effectively being the only nationally available plan), then the deck is unfairly stacked in the favor of the government option.

Your employer chooses your health insurance anyway, and if their corporate income taxes are subsidizing the public plan, undercutting the cost of private insurance, they will dump you into the public option to save money. The penalties proposed by democrats for doing this are so small that the public plan plus the penalties would still be less than a state approved private plan. That is not “free market competition” at work. It is extortion.

Do know that a public option that could compete with private industry was never designed to be a single payer system, but many characterized it as a trojan horse that would eventually lead there.

Many did characterize the public option in that way, including the guy who invented the idea and sold it to the Obama campaign in 2007, Jacob Hacker. Get a load of this:

““Someone told me this was a Trojan horse for single-payer. Well, it’s not a Trojan horse, right? It’s just right there. I’m telling you. We’re going to get there, over time, slowly, but we’ll move away from reliance on employer-based health insurance as we should, but we’ll do it in a way that we’re not going to frighten people into thinking they’re going to lose their private insurance.”

Orwellian, isn’t it? It appears you are incorrect Justin, and you fell for the ruse. Its a good thing most of the rest of the public didn’t.

In other words, do you think one monolithic provider competing against many localized private companies will do better than many localized public options that are in line with the needs of the community?

The only reason why private insurance may seem monolithic, is because the government keeps it that way. The only insurance plans the government allows you to buy are local, there is no real competition in the private sector now. The insurance plans the government does allow your employer to buy are so heavily regulated that they have to be big in order to remain solvent.

Besides what does “the needs of the community” have to do with anything? Health care is individual in nature, at least when talking about coverage for injury and illness.

I don’t think small co-ops will not be particularly cost effective unless the member ship limits itself to low risk members and it unclear under what rules co-ops can be formed. Large national ones may be better, but in the end competition is going to be not going to keep costs down very much since the providers don’t have a reason to keep costs low. You think that United Health Care or Blue Cross is going to let some doctor give some co-op a break they don’t get? Heck no so the provider isn’t going to give it to anyone.

Small local companies are objectively much worse at this than big ones. They have no negotiating clout outside their home base, so there’s no way in hell they’re getting a good deal from providers. Lots of small companies means lots of different bank accounts, billing systems, etc. That adds administrative costs. There’s a reason the Public Option was supposed to save us $150 Billion.

They’re also inherently high-risk. Let’s say one member has triplets prematurely. Total bill $10 million. The company needs to get that $10 million from it’s members, and if it only has 10,000 members because it’s the North Dakota co-op, there are only 600k in the entire state, 80-90% of those 600k are not using the Health Insurance Exchange (total ND market 60,000-120,000), and it’s market share is only 10% all those people are on the hook for $1,000. If nobody else gets sick that year that’s fine, but in insurance terms the risk pool is way too small.