The Edwards Health Plan

I need to get back to spraying Zicam and complaining about my cold, but I'd be remiss not to offer a quick rundown of John Edwards's just-released health plan (pdf). The short answer: It's good.

Here's how it works: On first blush, the plan is much like the Wyden initiative, though it puts the onus of the responsibility for funding health coverage on employers, a decision I don't quite understand. The employers can satisfy that responsibility by either providing comprehensive care, or helping employees purchase from a menu of insurance options provided by newly formed, state-run "Health Markets."

As of now, the plan doesn't explain how much employers must provide towards health market coverage, but it's a safe bet to assume that it's somewhat less than the total cost of health care, and so the incentive will be for employers to encourage their employees to purchase from the HMs. And that's where things get interesting. The HMs will offer a menu of private options that are totally community rated. The plan "will require insurers to keep plans open to everyone and charge fair premiums, regardless of preexisting conditions, medical history, age, job, and other characteristics." These days, though, community rating is a common enough.

Where the Edwards' plan takes a big step forward is in mandating, along with the private options, that HMs offer "at least one plan [that] would be a public program based upon Medicare." And the intent is explicit: "Health Markets will offer a choice between private insurers and a public insurance plan modeled after Medicare, but separate and apart from it. Families and individuals will choose the plan that works best for them. This American solution will reward the sector that offers the best care at the best price. Over time, the system may evolve toward a single-payer approach if individuals and businesses prefer the public plan."

In other words, the public sector will finally be allowed to compete with the private sector, and consumers will be able to decide which style they prefer. For Democrats, this is a significant step forward. From there, the plan offers the usual mix of sliding subsidies to ensure affordability, individual mandate to universalize coverage, pay-for-performance promises, and public health fixes. You've heard those bits before. What's new, and what's important, are the community rated health markets that include public insurance. Indeed, the plan satisfied every plank of my progressive health reform test from last week.

The plan will cost between $90 billion and $120 billion a year, and according to Edwards, taxes will have to be raised to pay for it. Readers should remember that this is the first full health reform plan from a major candidate in the 2008 election. As such, it has widened the field of the debate, and unless the other candidates want to explain why they lack the boldness of Edwards' plan, they'll have to offer similarly comprehensive proposals. What they will have to match is full community rating, a public insurance option, total universality, scaleability towards more public involvement, and a willingness to propose something comprehensive enough to require revenue increases to fund. In other words, the goalposts have been moved. To the left.

Crossposted to the lovely Tapped.