Public plan choice simply means making a public health insurance plan modeled roughly after Medicare available to anyone – on the same terms under which other plans are available. The case for public plan choice is simple. First, public health insurance outperforms private insurance in controlling costs while maintaining access and benefits. Second, public insurance has also made major strides in quality improvement, and a new public plan working with Medicare alongside private plans would be able to make much greater strides in the future. Third, a competing public plan is essential to set a benchmark for private plans, providing a "check and balance" to ensure that private plans, as well as the public plan, uphold high standards.

Jacob Hacker, professor, University of California, Berkeley

It is possible to structure a new insurance marketplace so that public and private health plans compete on a level playing field. This will require separating the oversight of the public plan from that of the managers of the marketplace. It will also require that all rules of the marketplace – benefit package requirements, insurance regulations and risk adjustment processes – apply to all plans equally, whether public or private. Finally, this model requires that we address cost growth containment systemically and avoid relying heavily on the public plan's potential market power. In turn, this will require a commitment on the part of policymakers to acquire a health information infrastructure, develop best practice information and encourage realigned incentives that promote high-quality, efficient care for all.

Len Nichols and John Bertko, The New America Foundation "A Modest Proposal for a Competing Public Health Plan"