National Journal’s cover story last week (“The Deal Busters“) was about the 4 issues that could kill health reform. And first on the list was creating a public health insurance plan option to compete with private insurers in the push for increasing coverage.

The National Journal does a great job of describing the stakeholder groups’ political pros and cons around a public plan, but it doesn’t delve too deeply into the policy implications of expanding health insurance coverage with or without a new public plan option.  That issue was recently discussed in Charlie Baker’s blog – which included several key points about public versus private insurance plans:

1. Public plans often set the standard that private plans follow, and thus are not neutral actors in the market – Medicare is often ascribed such a market tilting role
2. Public and private plans face different financial pressures, i.e.

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One of the looming questions for health reform legislation in the 111th Congress is how will it be paid for?  Or will that be less of a concern because deficit spending in a recession is deemed to be OK?

In earlier times, (i.e., 1990s), the projected costs of legislation had to be “paid-for” under the so-called PAYGO rules – which stands for “pay-as-you-go.”  However, in recent years those rules have lapsed or been waived.

Three recent nuggets of information indicate that transparency in the legislative process may be replacing PAYGO in the coming years.  First was the Obama Transition Team’s extra-ordinary level of transparency, exemplified by their policy of having information from all meetings with outside groups being posted on the Change.gov…

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