Optional Support For The Public Option

Jim Geraghty writes the Campaign Spot on NRO.

Nothing is final until the votes are cast and counted, but quite a few Senate Democrats on key committees have expressed nagging doubts about the bill's most controversial component, the public option. This would set up a government-run health-insurance system that would compete with private plans; critics contend that a government-run plan with no profit motive and with the pricing power of the federal government could quickly put private plans out of business - a gradual, not-so-inadvertent slide into socialized medicine.

Keep handy this review of positions of Democrats, many of whom are on the key committees - and keep in mind that Senate Republicans are ready to remind Democrats of these previous clear positions if they wilt in the face of White House pressure.

Sen. Max Baucus of Montana suggested to Time magazine in March that he saw the public option primarily as a bargaining chip: "Essentially, it's to keep [the public option] on the table to encourage the private health-insurance industry to move in the direction it knows it should move toward - namely, health-insurance reform, which means eliminating pre-existing conditions, guaranteed issue, modified community ratings. [Translation: measures that would force the insurers to cover the sick as well as the healthy, at a cost that everyone could afford.] It's all those actions that insurance companies must take in order to provide affordable coverage. And the public option helps encourage the private companies to move in that direction, because they're worried. We might have to modify the public option to get enough votes. I hear some concerns among Republicans about the public option. The main purpose is to keep the health-insurance feet to the fire."

Sen. Kent Conrad of North Dakota is shopping an alternative where a system of federally chartered co-ops could offer a non-profit alternative to the for-profit insurance industry. He told the Washington Post's Ezra Klein that he was working on the alternative because there weren't enough votes for the public plan.

Sen. Blanche Lincoln of Arkansas is hedging but sounds skeptical: "My concerns that I've expressed is [sic] that it's got to be one that works on a level playing field." If there's just a government plan, "there will be very little incentive for the private industry to be able to be competitive perhaps in the plans they will be offering and the individuals they will be offering."

Sen. Mary Landrieu of Louisiana is a pretty clear no: "A public option is not something I support. I don't think it is the right way to go."

With each successive statement, the position of Sen. Ben Nelson of Nebraska gets a little muddier, but it will be tough for him to reconcile statements like "It's a deal-breaker for me if there's a government-run plan to replace existing insurance plans" with a vote for a public plan.

It's understandable if folks are wary of any promise from the Senate's newest Democrat, Arlen Specter of Pennsylvania, but in his Meet the Press interview with David Gregory, when asked, "Would you support health-care reform that puts up a government-run public plan to compete with a private plan issued by a private insurance company?" Specter responded, "No, and you misquote me, David - I did not say I would be a loyal Democrat."

Sen. Ron Wyden of Oregon is generally supportive of the public option, with some conditions. This is from his website: "With regard to a national public option, Senator Wyden has made clear that he is not wed to the approach he put forward in 2006 and is open to a national public option on Day One#. . .#if it is accompanied by real reform that is responsibly and sustainably financed."

The Spokane Spokesman-Review describes Sen. Maria Cantwell as "cool to a centralized public-option health-care plan."

Then you've got the kinda-sorta-maybes among the Democrats. Earlier this month, Sen. Mark Begich of Alaska offered the very honest answer, "I'm not sure where I fully stand at this point." In April, Sen. Evan Bayh of Indiana described himself as "agnostic" on the issue during a Fox News Sunday appearance, and recently described himself as undecided. The staff of Sen. Jon Tester of Montana will say only that he will weigh and investigate all the options.

Many other influential Democrats on the key committees, like Sen. John D. Rockefeller of West Virginia, strongly support the public option, and Sen. Jeff Bingaman of New Mexico cosponsored a resolution demanding that any health-care-reform bill include a public-insurance option.

Democrats offered a number of reasons for their opposition or wariness: They don't see it as central to reform, or concur with Republicans that it would slowly strangle private health-insurance plans. Unspoken is the fear of consequences: What if a government-run plan ends up being a bureaucratic flop that patients hate? And then there was the man once slated to head Barack Obama's health-care-system overhaul, Tom Daschle, concurring with former Senate Majority Leaders Bob Dole and Howard Baker that a public plan just wouldn't have the votes, and would sink the bill.

But Republican leaders speculate that the hesitation reflects the rapid and gargantuan expansion of government in the early months of Obama's presidency. "Most Democrats support [the public option], but some are starting to realize the consequences of having the government run more and more of the economy," says Don Stewart, communications director for Senate Minority Leader Mitch McConnell (Ky.)

By Jim Geraghty
Reprinted with permission from National Review Online