Mike Leavitt, the former head of the Health and Human Services Department in the Bush administration, opposes the inclusion of a public plan in health care reform that would compete with insurance companies. It would be too easy to dismiss his opposition as special interest driven since he is now "building businesses to advise and investment in health-care companies and he's working with a Blue Cross insurer on payment issues." But his main criticism, expressed during an interview with David Hilzenrath of the Washington Post, identifies the major problem with creating a public plan that piggybacks on Medicare:

In recent years, planned reductions in Medicare payments to doctors were repeatedly deferred, because Congress prevented them from taking effect, Leavitt said. Similarly, Congress authorized competitive bidding for medical equipment -- and then bowed to pressure from industry, putting a stop to the initiative just as it was being implemented, he said.

"[I]n a system that's run by the government, lobbyists and various commercial interests, including doctors, hospitals, nurses, medical equipment dealers and every other part of the system, use the political process to restrict the capacity for change," Leavitt said.

The solution to this problem isn't eliminating the public plan from reform. Rather, his argument supports the idea of getting Congress out of the business of micro-managing Medicare payment policy. The way to do that is to create a strong government agency -- a Medicare Payment Advisory Commission on steroids -- to set specific Medicare payment policies within the broad parameters for coverage that can still be set  by Congress.