Top Democrats agree on health-plan basics

WASHINGTON -- Hillary Rodham Clinton, Barack Obama and John Edwards have been sniping at each other for months over health care, but there's one thing the top Democratic presidential candidates agree on: Americans of all ages should have the choice of buying a government-run insurance plan modeled on Medicare.

The idea, which would set up competition between a new government plan and private insurance programs, is one of the most far-reaching and controversial proposals for making health insurance more affordable and more widely available.

In the Clinton, Obama and Edwards proposals, the government would offer coverage for middle-class workers and their families, with comprehensive benefits comparable to those now provided for federal employees and members of Congress.

Participation in the government alternative would be voluntary, but the approach sparks widely differing reactions.

Mark B. McClellan, the former Medicare administrator in the Bush administration, called it a risky departure from the state-based reforms that the Democratic candidates have cited as their models.

What McClellan, now with the Brookings Institution, and other critics say they fear is that the government plan could underbid private insurers and, if large numbers of people sign up, it could eventually replace private coverage, including the employer-sponsored plans that now serve most middle-class Americans.

Some also fear that the government program would end up as a dumping ground for the most seriously ill -- and expensive -- patients as private companies cherry-picked those least likely to file large claims. If that happened, the cost of the government program would soar.

Despite these concerns, other respected experts say that giving people the option of joining a government plan might make for a sensible experiment.

"It could be a really fair way to test the market," said Marilyn Moon, a health economist and former trustee of Medicare and Social Security.