It means that you can choose to buy a plan that meets what you're looking for. Such as, Massachusetts has a shit ton of things that have to be included in a policy: pediatric dentistry, fertility treatments, etc. I think Mass has like 50 mandates of things that an insurance company must cover. Fuck that. I want to shop for a plan that only covers what I feel like having covered and am willing to pay for. But, the dear lknow-it-alls who run this state want to force everyone to have the same coverage.
If you could buy a plan from say Ohio that was just basic and covered what you wanted covered, it'd cost a lost less. Clearly someone isn't going to select a plan that restricts them to providers in another state. You'd probably see an out-of-state company work with an in-state company to access its network for a fee, at least until they could establish their own provider network. But it'd still be a lot cheaper than having everyone pay for a gold-plated policy that they don't necessarily want but have to buy if they want insurance. And in Mass, you have to buy or you get penalized.
Yeah, that last part applies to every US resident now. Sometimes I suspect Obamneycare was just a Trojan horse attack on private insurance itself: "No, we cannot do it without single-payer, because we tried that with Obamneycare, and look how badly it worked."
I still prefer a hybrid system, and the point you and Tom raised is a good example of why: Public health insurance ensures EVERYONE (or at least all legal residents) basic healthcare because that is part of why we pay taxes, but people who want more can still buy it privately. No one falls through the cracks, because we establish a universal baseline guaranteeing everyone preventative and life-saving healthcare, but people who "need" a private room or Viagra can shop for it privately, because We the People have neither the need, means nor desire to ensure everyone a boob job. The public system would guarantee private insurance quality never fell so low everyone abandoned it for the comparable but cheaper public option, while the private system and public oversight would guarantee the public system never became so expensive everyone abandoned it for comparably priced yet higher quality private option.
A big part of what bothers me about the US health insurance debate is that nearly everyone on both sides treats "single-payer" and "public option" as synonymous when they are anything but: "Single option" is a contradiction in terms.
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