As the current health care reform bill rattles its way through the legislative process, Republicans and Democrats alike continue to grapple with a central question of the debate: whether to create a public option or a government-run health care alternative for those who either can’t afford or lack access to other private alternatives.

Proponents of the public option argue that without some government intervention into the health care market, private insurers will continue to drive up premiums and other costs because they hold near monopolies in many areas throughout the country.

But the notion of handing even a part of the nation’s health care system over to the government has been a point of consternation for some, who worry that ballooning fiscal obligations could bog down the federal budget for decades to come.

Amid these deliberations, The Michigan Daily sat down with five experts on health care reform from the University’s faculty to discuss the debate between private insurance companies and publicly funded alternatives.

While some express concern that a public option would bring premiums and medical costs down so low it would drive out competition and put private insurers out of business, Matthew Davis, associate professor of the School of Public Policy, disagreed.

Davis, who is also an associate professor of Pediatrics, said that if the health care reform bill passes, Obama will be bringing more than 40 million uninsured people into the market, increasing the number of patients for insurance carriers.

“There is a very strong economic argument that when Americans want more Americans to have coverage, that’s going to control growing health care costs,” Davis said.

He added that it is the uninsured who currently drive up health care spending by waiting and only seeking medical attention when a problem gets critical and very expensive to fix — all while the insured cover the tab.

“When the uninsured in America need to get health care and can’t pay for it, then the people with coverage end up paying for that care through higher premiums,” Davis said.

Besides the possibility that the government will corner competition, opponents of the public option are also concerned that insuring the high-risk uninsured will drive up health care costs for everyone else. But, according to Dean Smith, senior associate dean of the School of Public Health, those with private insurance are already footing the bill for those patients.

“Just because they don’t have insurance doesn’t mean they don’t show up at the emergency room,” Smith said.

Smith is part of a team at the University that has had firsthand involvement with the legislation making its way through Congress. He works at the University of Michigan Center for Value-Based Insurance Design, which helped develop the concept of value-based insurance.

The idea, which was included in the bill, advocates that the value of the patient’s clinical benefit should be equal to the amount of money spent. For example, cosmetic surgery, which holds relatively small value for health, would be more expensive.

But despite the public option’s potential for immediate cost-effectiveness, some economists and public health experts are concerned with the legislation’s possible long-term economic ramifications.

Many who are critical of the new legislation point to the evolution of Medicare, which has changed steadily since its institution in 1965, and subsequently increased the government’s role in determining pricing for health care.

“When Medicare first started, (the government) said Medicare would not be in the business of setting hospital prices,” Smith explained.