After weeks of waiting and wondering, leaders in both chambers of Congress have announced their intentions with respect to the public option. House Speaker Nancy Pelosi is rounding up the votes for a bill with a government insurance plan that will negotiate rates with providers. Senate Majority Leader Harry Reid is standing behind something similar--with the addition of a clause allowing states to opt out--and is trying to keep his caucus together in the face of unanimous Republican opposition. But what about the rest of reform?
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Right now, it's impossible to compare what the Senate is trying to do with what the House is trying to do because Reid hasn't unveiled his bill yet. But though there will surely be some major differences, both proposals will contain some of the same underlying architecture.
The basic theme of health care reform is that insurance would be mandatory, subsidized and regulated. As is the case today, for the first many years after enactment, most people in the country would be insured by their employers--in fact, large and medium-sized businesses would be required to provide insurance for their employees. Uninsured people would either be roped into existing entitlement programs like Medicaid, or required to buy regulated insurance--typically through an "exchange," which, comprised of hundreds of thousands, or even millions, of customers, would theoretically have the bargaining power needed to keep premiums down.