Private Markets vs. Public Programs: What state private insurance market reform and managed care tell us about cost control and expanded coverage under the Patient Protection and Affordable Care Act?

State-based experience with managed care and private health insurance market reform has not to date had a significant effect on cost control or coverage. Despite the failure of these reforms at the state level the Patient Protection and Affordable Care Act adopted many of the same insurance market reforms that have failed at the state level to significantly control costs or expand coverage.

Public program expansions have been more likely to provide health insurance at an affordable price per additional person covered than subsidies or tax credits for the purchase of individual private insurance policies. International experience suggests that national health insurance based on an improved and expanded Medicare for all Americans may be the better policy option to accomplish universal coverage and a high performance health care system at little or no added cost.