Will There Be a Public Option?

I have waited a long time to even bother writing much about the "Public Option" because,

a) it may not even make it into a bill
b) will have minimal impact on most of us
c) you wouldn't know a) or b) going on the amount of news coverage about it

There are many really good as well as potentially problematic items that made their way into at least 1 of the 4 measures that were reviewed by the House or Senate. The "Public Option" has gotten a disproportionate amount of the coverage and most of it (on both sides of the issue) is misleading at best. I really don't think most of the public really understands much about the "Public Option", but be that as it may, according to a Washington Post/ABC News poll this week they are starting to become more in favor of it (whatever they believe "it" is).

Assume just for a moment that some form of a Public Option winds up being in the final bill signed into law by President Obama.

IF it winds up being "live" rather than waiting for a "trigger event"

IF it winds up being nationwide, rather than voted in or out on a state by state basis

It is still very unlikely that MOST Americans will have the OPTION of selecting the "Public Option" for their Health Insurance. It is very, very likely, that it will only be made available to those who do not qualify for insurance through their work or their spouse's employer. These people have already been able to get "private insurance", but in most cases it is very expensive. It is most likely that "Public Option" insurance will still seem expensive to those considering it, just less expensive than their other options.

A "Public Option" will NOT:

Incent businesses to drop their Health Care offerings (although the total upheaval of acquiring health insurance and making it more like auto insurance would dramatically reduce the overall cost).

Be selected by more than 10-15% of the populace.

Dramatically reduce health care rates (but it will keep them somewhat in check in future years)

Lead to the government takeover of the Health Insurance Industry

Lead to Socialized Medicine (if you hear anyone say this, remind them that the "Public Option" is for Health INSURANCE not Health CARE, and that they need to change the channel on their TV to something other than Fox News).

So, getting back to my topic today...Will there be a Public Option?

YES.

How we get there and what it will look like has very little to do with what is best for the country and everything to do with Politics and Money (this may be true about most laws).

The bill that passes in the House OR the Senate needs to have some flavor of the "Public Option" in it in order for the final law to have it. They do NOT both need to have it. In the final sausage making process of this law, the passed bills from the House and Senate get reconciled and as long as one of them have some language on a "Public Option" it is likely that the final bill signed into law will have something. So Harry Reid in the Senate and Nancy Pelosi in the House don't both have to be successful finding votes for the "Public Option", just one of them needs to get the right number of votes.

The Senate needs 60 votes to prevent a filibuster. There are 58 Dems, 2 Independents and 1 Mountain of Republican Snowe. There are a few conservative Dem Senators like Ben Nelson (NE) and Kent Conrad (ND) who are holding out on supporting a public option, mostly for the benefit of their political future. Harry Reid just needs to find a way of helping them keep face with their constituents. Enabling states to "Opt Out" will probably be enough for one or both of them. Senator Joe Lieberman (CT) the Independent who votes all over the place, but mostly for self-preservation, may not be as easily swayed since the Insurance Companies are clustered in his state. Which is why Olympia Snowe (R-ME) gets to control the final huddle in the Senate. Reid will giver her what she needs to vote for cloture and prevent a filibuster. Only 50 votes are needed for the bill once it comes to a vote (Joe Biden would break a tie) and I am guessing that some Senators (probably including Snowe) may vote for cloture to allow the bill come to a vote, but would then vote against the bill.

Pelosi needs about a dozen Blue Dog House members to vote for their bill (no filibuster in the House). It seems that it may come down to money as many Blue Dogs represent states with lower than average Medicare reimbursement rates - the guideline for payments in the currently proposed "Public Option" plan. Tweaking this or enabling hospitals to negotiate with providers could be enough to let out the Blue Dogs and get to the magic number of 218 votes. This Medicare rate issue is also probably the main sticking point for Senator Kent Conrad.

It takes money to make sausages.