As it stands, the public option is to get start up funds, but be entirely self sustaining from premiums only, for all time. They have to negotiate rates, the same as any other insurer, with no powers of coercion (e.g. take Medicare reimbursement rates.) I haven't a clue how this is supposed to work. It is generally accepted that higher cost individuals are supposed to end up there. They say the population will be tiny (3m?). Who is going to negotiate with it unless they have some other buying power we don't see? It should either shrivel or grow if it's free market as they say. The Feds are going to watch them shrivel and die with a hands-off policy?

Actuarial musings