Both Switzerland and Germany have private insurance regulated heavily by the government and delivered via mandated minimums for qualifying plans, which the insurance companies have no choice but to provide.

They compete, mostly, on price and service. Supplemental plans are also available to provide medical services that the government mandated plans don't provide. I couldn't tell you off the top of my head what the list would look like, but both countries allow for negotiations between the insurance industry and medical providers to set prices for the government mandated plans.

The plans currently on the table in various committees, as Fred mentioned, creates a public option of some sort for the uninsured, the self employed and small business with under 20 employees. Further, they regulate the most egregious abuses of the current private insurance system such as preexisting condition exclusion and canceling a policy because some got sick. I believe most of the plans seek to standardize care via information technology and best practices as a way to control costs in addition to the measure above. I believe one of the bills addresses the current Medicare program as well and seeks to stem some of its bleeding as these other reforms are implemented.

What seems to be missing is reform medical delivery abuses, medical malpractice (most of which goes unreported) and the pharmaceutical industry, not to mention the FDA and their gutless and underfunded "regulation" of our food and drug systems.

jonnienohands: Hold on. How are my questions loaded? The first one was an indication that I had heard opponents of reform claim over and over that a public option would not work because private companies would not be able to compete. The implication often made was that reform advocates know this but don't care because they really want a government program. I had not heard any answer to this, let alone a good one. I do not have time to go and read up on this, so I thought that I would reach out to the TPM community - a community that I find to be wise on many matters - to see if someone could set me straight in short order. Thus, I fail to see how that question was loaded.

The second question sought to find out if there is a major alternative proposal floating out there other than 1) Public option, 2) Single-Payer, 3) the status quo. How is that loaded?

The third question had to do with a genuine puzzle for me, one that was important in health care debates I have with my conservative business-type neighbors. ALL OF THEM admit that businesses should not be in the business of providing health care, something that I with which I agree, and having agreeded with them, then ask why they don't support reform. When I heard that the plans in Congress still focused on business provided health care, I was confused.

Look. I like to think that I am not a knucklehead when it comes to public policy. A general sign for me that the public discussion of an issue is not going well is when I cannot understand what the heck is going on, even when I have made a little effort to figure it out myself.

My reply to Fred was both sincere in its gratitude and sincere in the desire to continue the conversation.

What is to be gained by impugning my honesty in this conversation?

I became so intrigued with the Netherlands universal healthcare system I linked to above, that I reproduce the Wikipedia description below. Some components are government run, but most medical care is covered by private insurers that compete with each other.

What is striking is that the Dutch have regulated insurers so as to reward the best service for the lowest cost, and to prevent insurers from taking steps to reduce costs by reducing services, denying claims, excluding high risk individuals, or any of the other maneuvers that discourage good and affordable service. In essence, in the Netherlands, the only way to be more profitable is to be more efficient, not to be stingier. Here is the Wikipedia section:

"The Netherlands has a dual-level system. All primary and curative care (i.e. the family doctor service and hospitals and clinics) is financed from private compulsory insurance. Long term care for the elderly, the dying, the long term mentally ill etc. is covered by social insurance funded from taxation. According to the WHO, the health care system in the Netherlands was 62% government funded and 38% privately funded as of 2004.[6]

Insurance companies must offer a core universal insurance package for the universal primary, curative care which includes the cost of all prescription medicines. They must do this at a fixed price for all. The same premium is paid whether young or old, healthy or sick. It is illegal in The Netherlands for insurers to refuse an application for health insurance, to impose special conditions (e.g. exclusions, deductables, co-pays etc or refuse to fund treatments which a doctor has determined to be medically necessary). The system is 50% financed from payroll taxes paid by employers to a fund controlled by the Health regulator. The government contributes an additional 5% to the regulator's fund. The remaining 45% is collected as premiums paid by the insured directly to the insurance company. Some employers negotiate bulk deals with health insurers and some even pay the employees' premiums as an employment benefit). All insurance companies receive additional funding from the regulator's fund. The regulator has sight of the claims made by policyholders and therefore can redistribute the funds its holds on the basis of relative claims made by policy holders. Thus insurers with high payouts will receive more from the regulator than those with low payouts. Thus insurance companies have no incentive to deter high cost individuals from taking insurance and are compensated if they have to pay out more than might be expected. Insurance companies compete with each other on price for the 45% direct premium part of the funding and try to negotiate deals with hospitals to keep costs low and quality high. The competition regulator is charged with checking for abuse of dominant market positions and the creation of cartels that act against the consumer interests. An insurance regulator ensures that all basic policies have identical coverage rules so that no person is medicially disadvantaged by his or her choice of insurer.

Hospitals in the Netherlands are also regulated and inspected but are mostly privately run and for profit, as are many of the insurance companies. Patients can choose where they want to be treated and have access to information on the internet about the performance and wait times at each hospital. Patients dissatisfied with their insurer and choice of hospital can cancel at any time but must make a new agreement with another insurer.

Insurance companies can offer additional services at extra cost over and above the universal system laid down by the regulator, e.g. for dental care. The standard monthly premium for health care paid by individual adults is about €100 per month. Persons on low incomes can get assistance from the government if they cannot afford these payments. Children under 18 are insured by the system at no additional cost to them or their families because the insurance company receives the cost of this from the regulator's fund."