The Treatment

Sad, if Predictable: Finance Rejects Public Option

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Two public insurance options put up for a vote. Two public insurance options voted down by the Finance Committee.

The count was fifteen to eight against the first amendment, which came from Jay Rockefeller and would have allowed the public plan to set its payment rates based on Medicare. The vote was a bit closer on the second amendment. That proposal, which came from Charles Schumer, would have prohibited the public plan from setting reimbursements so low.

The difference was two Democrats, Thomas Carper and Bill Nelson, who voted against the Rockefeller version but for Schumer's scaled-back alternative. Three other Democrats voted against both proposals: Max Baucus, Kent Conrad, and Blanche Lincoln.

This is not the slightest bit surprising. But it's still frustrating.

The idea of a public plan makes sense substantively. The strong (Rockefeller) option could actually save a lot of money--money very much needed to help underwrite the cost of expanding health insurance. The weak (Schumer) option wouldn't save a bunch of money, but it would still help discipline private insurers while providing a reliable source of comprehensive coverage. There are reasonable objections to the public plan, for sure, mostly about the danger that a public plan would set prices so low as to starve providers. But the concern is overblown, particularly since advocates of the plan have come up with some pretty good safeguards.

The idea also happens to be popular. Most polls have shown the voters like the idea of having a Medicare-like option into which they can enroll voluntarily, although those who oppose it may feel more intensely. If the public plan didn't threaten the revenue stream of every major health care industry--and if the mis-apportioned U.S. Senate were remotely representative of the U.S. population--today's votes might have gone differently.

I've been among those urging people on the left not to make too much of a public insurance plan--that reform without such an option is still worth enacting. I still believe that. But I also believe the public plan is a good idea. And it's more than aggravating to see good ideas meet this fate.

Not that it's fate is sealed. Finance is but one committee--an important committee, to be sure, but one all the same. The bill from the Senate Health, Education, Labor, and Pensions (HELP) Committee has a public plan. So do the bills that came out of three House committees over the summer. Senator Harry Reid has indicated he probably won't include a public plan when he merges the Finance and HELP proposals, but there will be a chance to add one duirng the floor vote debate and then again during conference committee deliberations, assuming the House passes one.

The odds are against enactment, particularly for the Rockefeller amendment. But Schumer's, which is more or less identical to HELP's, may be able to get fifty votes. Then it becomes a question of whether moderate Democrats, even those voting against the public option, would break ranks and uphold a filibuster over it--and how much Democratic Party leaders, including the one sitting in the Oval Office, care about the one or two Republican votes they stand to lose over this issue.

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