Senate healthcare reform debate begins: public option topic No. 1

In the Senate, debate began Monday on healthcare reform. A look at the senators' likely votes makes it difficult to see how the public option, as it is currently constituted, can survive.

Is the public option dead again – this time for good?

As the Senate opens debate Monday on its version of healthcare reform, the public option – a government-run health plan intended to compete with private insurers – remains one of the bill’s most controversial issues.

Liberals say the public option is necessary to keep the insurance industry honest. Conservatives, and some moderates, say it might result in too much government intrusion into the healthcare sector of the economy.

The problem for Sen. Harry Reid, the majority leader, is that he needs to win the votes of centrist skeptics of the public option, such as Sen. Ben Nelson (D) of Nebraska, if he is to round up a filibuster-proof margin of 60 votes.

That math makes it difficult to see how the public option, as it is currently constituted, can survive. And that might not be as big a disaster as liberals believe, according to one prominent health economist.

“Politically, [the public option] is extremely important. Substantively, I don’t believe it is nearly as significant as either its opponents or supporters believe,” said Henry Aaron, senior fellow in healthcare studies at the Brookings Institution, in a Web video.

The Senate debate beginning this week is sure to be a long, and long-winded, affair. Senator Reid would like to wrap it up by Christmas, but at this point he has no clear way to get the 60 votes needed for victory.

The hot-button question of abortion could still derail the bill. So could the concerns of some senators over its cost.

And so could the public option, an issue whose prominence appears to have surprised and frustrated the White House.

Administration officials have long said that a public option might be the best way to lower costs and induce competition in the insurance arena. At the same time, they’ve declined to say that a public option is a must-do in a healthcare overhaul.

Last week, White House budget director Peter Orszag held a conference call with reporters on the health reform effort. He talked about what he called the “four pillars” of a fiscally responsible health-reform bill.

Those pillars included such things as a tax on high-cost health plans. But the public option was not one of them. In fact, Orszag did not even mention it.

The version of the public option currently included in the Senate bill would allow states to opt out of the system.

As to the opinions of crucial swing-vote senators, Senator Nelson has said he might support a public option that ran the other way – allowing states to opt in, rather than opt out.

Sen. Mary Landrieu (D) of Louisiana has said she could live with a trigger mechanism that would activate a public option if private insurance costs rise beyond a certain point.

Sen. Olympia Snowe (R) of Maine is another supporter of the trigger option.

Sen. Blanche Lincoln (D) of Arkansas and Sen. Joseph Lieberman (I) of Connecticut sound as if they remain staunchly opposed to the public option, however.

Last week, Senator Lieberman said he would remain “stubborn” in his opposition.

It’s possible a compromise – or an attempt at compromise, at least – may be in the works. Sen. Thomas Carper (D) of Delaware is among a group of lawmakers attempting to draw up something resembling a public option that meets the moderates’ concerns.

The compromise is far from set. But it might entail a national insurance plan that covers states where private insurance does not meet a threshold for affordability.

See also the Monitor's series on healthcare holdouts:
Ben Nelson says abortion funds mean ‘no’ vote

Mary Landrieu likes her $300 million

Blanche Lincoln wants to focus on jobs

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