“The Public Option Is Back in Play”—That Depends Upon Your Definition of the Word “Is”

It appears that Harry Reid is going to include a robust Medicare-like public option in his Senate draft. Speaker Pelosi is also doing her best to put as robust a public option in her House version as she can get the votes for.

One press report after another has proclaimed the return of the public option.

I’d like to see some of these reporters to do a vote count.

No doubt the hype over the public option is at an optimistic level. No doubt Reid and Pelosi’s opening bid will be aggressive on the public option issue.

But the reality?

In the Senate you will find the only health care game in town that in the end will matter--how to get to 60 votes.

There haven’t been anywhere near 60 votes for the robust public option all year, or even something close to it, and there are not today.

Reid is reportedly going to include a robust Medicare-like public option with a state opt-out. That means there would be a federal Medicare-like public plan but that a state could opt out. Opting out would mean that both houses of a state's legislature and its governor would have to agree to opt out. That’s a pretty high hurdle and it is not going to appease the moderate Democrats in the Senate, or any Republicans including Snowe, who oppose a robust public option.

We could have a public option only if a “trigger” occurs. That is Senator Snowe’s general idea. OK, define that trigger. Do you think for one moment a liberal’s definition of a trigger will come close to a moderate’s definition of a trigger? It is the last week in October and we’ve been hearing about a trigger for months. Have you seen a definition of it yet?

Then there is the possible course in the House—a public option that has to negotiate with providers just like a private health plan does—“arms’ length negotiations.” For liberals, how is that different than a co-op and its inability to gain any real kind of traction? For moderate Democrats, it will likely be seen as the “wolf in sheep’s clothes.” Maybe a place to compromise but hardly the robust government plan its proponents are looking for and there is no evidence that this idea will attract those moderate Senate Democrats that don’t like the public option.

Then there is the state opt-in. The idea is that both the state’s legislative branches and the governor would have to agree to opt-in. This could well win moderate Democratic support because very few states would do it and it is attractive to states' rights moderates who would like to see state experimentation. This is a possible place for compromise but hardly a robust public option.

As I have said many times before, there will not be a robust Medicare-like public option or any form of a thinly veiled Medicare-like public option. When the day is done liberals will be satisfied to get what they can to get a bill across the line.

In my mind, the bigger issue continues to be how Democrats will balance individual affordability and paying for the thing.