A Public Plan
[I'm hoping this education example will give some insight into the public health care plan, or at least give you another way to think about it.]
Suppose that education is only available from private sector schools (last I checked the government was running more than 50% of the health care in the US), and that education within this system is very expensive (expense is a highly subjective measure, we have the best health care in the world as reported by the WHO). Because of the expense, millions of people do not have access to education (I'm not sure if you are comparing this the health care or insurance. Emergency care by law is provided for anyone enertering a hospital). Further suppose that due to the characteristics of the education market, there is reason to believe that the private institutions are bloated with excess costs (and, in addition to all the other excess costs, 30% of their expenditures came from competition for students rather than delivering education) (or maybe finding fraud and waste which was estimated at more than 20% of payout for Medicaid last year). To make matters worse, the already too high costs are expected to escalate rapidly in the future and further limit access to education. (And there's more. If costs aren't controlled, the government's Educare program for the very young will begin to eat up a huge share of the federal budget.) (oh no! a government program with uncontrollable cost? You don't say!)
Now suppose the government decides to solve both the access and cost problems by setting up a public plan for education. Here's how it works.
The government will build schools, staff them, purchase supplies, and so on, but there's a catch. The schools will have to run without any government subsidies, none at all, not a dime (so this is different than what we actually do since some or all of the education bill is subsidized, some for college, all for lower grades). (I'm not sure how the government builds schools without money. The last high-school built here cost 61 million and was built on a swamp that falls more than a foot a year. Maybe they build the schools with hope dust? But who works for hope dust? Perhaps wide eyed progressives who know very little about health care other than a few absurd comparisons and to call everyone who disagrees a Randite)
If these schools provide exactly the same education as the private sector schools but cost less to attend, then that would either force the private sector schools to find a way to compete by bringing costs down, and they ought to be able to match the government run institution, or they would go out of business (or we could, you know, let private providers drive others out of business, oh wait, that happens all the time). It's true that the public institutions might have an advantage in buying books in bulk, that sort of thing, and they could probably get books and other supplies for less than individual private schools could get them, but what's wrong with scale economies?(economies of scale? and of course as any economist know, economies of scale often reach escalating marginal cost. Especially poorly designed monopolistic bureaucracies.) And to the extent that it is the power that comes from their size as public institutions rather than actual efficiencies, it's important to remember that the publishers aren't without their own countervailing market power, so this makes the playing field more level.
As to access, one option is to do as we do with schools now and implicitly subsidize everyone who attends, rich and poor alike, by giving government subsidies to the schools (tuition falls by the amount of the subsidy, to zero for public elementary and high schools, part way to zero for colleges). But that would violate the no government help rule we imposed above. The other way to do this is to take the money that would have been used to subsidize the schools and instead give it out to individuals who couldn't attend school otherwise (perhaps graduated by income). That avoids giving subsidies to those who don't need them, and the subsidies can then be concentrated on those who do. The additional help available to those who need it would, in turn, allow more people access to education, a key goal of the policy. (Perhaps we could construct the most convoluted system possible that was nearly impossible for the average person to understand it, and when 9 million people that qualify for it don't have it we could use that as justification for expanding it)
So, the idea is to build government schools that must run without any help from taxpayers, and the public schools will compete side by side with the private schools. (not sure what the difference is between this and the multiple non-profit school run by churches and other philanthropic institutions) Rather than limiting choice, this adds one more choice, and it's a choice nobody has to make if the public schools turn out to be more expensive than than the competing private schools (But as we've already stated, we are taxing everyone else to build those schools, then of course forcing everyone to teach the same way we teach so as the prevent any real cost savings) Then, to increase access to education, give individuals the tuition subsidies they need to make it possible for them to attend the public school. Finally, for any conservatives opposed to the public plan, notice that if individuals can use the subsidy on either a public or a private sector school, this is basically a voucher system. However, in this case the goal of the voucher system is to reduce costs in the overly expensive private sector rather than to discipline the public institutions, something the private sector shouldn't fear if, in fact, it is the least cost provider of education (Blah blah, evil markers and thought crimes).
