Oral

While many single-payer advocates have treated the proposal for a public health insurance plan as inadequate, the private insurance industry itself has called it a back-door single payer. They fear that, if they had to compete with a public plan, the public plan could under-price them in a market where buyers are very sensitive to price and practically drive them out of the health insurance market in a few years. The American Federation of State, County & Municipal Employees made the public plan its top priority in 2007 when California considered an individual mandate to buy health insurance. When health insurance reform went to the top of the national agenda in 2009, AFSCME joined with other unions to make the public plan a top priority in that debate as well.