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Why Health Reform Is Likely to Have a Public Plan


Huffington Post's Ryan Grim has been doing great work covering Sen. Ben Nelson's (D-Neb.) endless flips and flops on the public health insurance plan. A few weeks ago, you might remember that Nelson was talking about forming a "coalition of like-minded centrists opposed to the creation of a public plan, as a counterweight to Democrats pushing for it." Back then, the public plan was a "deal breaker."

Now? He's open to a public plan. Neat how that works. But Nelson isn't alone. Support for the public plan seems to have elevated in a few corners. Max Baucus (D-Mont.), previously cool to the idea, is now said to be fighting "tooth and nail" for its inclusion. Sen. Arlen Specter (D-Pa.), once a monosyllabic opponent ("no"), is now proclaiming himself open to the idea.

Meanwhile, the public plan's supporter -- Sens. Chuck Schumer (D-N.Y.), Ted Kennedy (D-Mass.), and others -- have organized and begun insisting, rather than merely mentioning, the idea. Liberal senators came together and signed a letter in support of the policy. The White House, which seemed relatively unsinterested in the issue a few months ago, has begun pushing hard for it.

And that, in my reporting, is what seems to be underneath the change. A few months ago, most observers thought the public plan was a bargaining chip. It had a lot of public supporters but few real friends. In recent weeks, that's begun to change. The White House seems genuinely intent on including a public plan -- or at least some form of public competition -- in the final bill. And that's changed the incentives for senators down the line. The public plan was safe to oppose so long as the powerful players weren't really interested in its survival. Indeed, when the policy was going to be bargained away anyway, the incentives were to try to convince the health industry that you'd been their key ally in that victory. But now that the White House has put some muscle behind the policy, opposition has potential consequences. And that's making the policy's opponents rethink their stridency.

A few months ago, I would have bet against the presence of a public plan in the final bill. Now I'd put my money in favor of it.

(Photo credit: AP Photo/Charles Dharapak)

By Ezra Klein  |  June 3, 2009; 11:17 AM ET
Categories:  Health Reform  
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Well, this is going to be a long, hard ride.

Posted by: leoklein | June 3, 2009 11:39 AM | Report abuse

long hard ride with no cerveza at the end of the trail.

Now, there's talk of a 'triggered' public option if the private insurers don't behave for a couple of years - an option to be exercised at some future date when it is forgotten. Stupidist idea of the month (vying for the year).

Under English Common Law, every dog is entitled to one free bite (on a human, I presuppose - not sure about dog on dog bites). Second bite, and presumption of visciousness takes over, and liability for the dog's acts. I don't know what happens on the third bite. Dog heaven, I guess.

The health insurance industry and the Wall Street Bankers have already had two bites (at least) each, and they're still acting like victims. Every congress person should be issued tasers to deal with these dogs, with vets (syringe in hand) standing by.

The health care insurance lobby isn't going to threaten just a bite. They want a whole meal, starting with the face and tender places.

Posted by: JimPortlandOR | June 3, 2009 12:05 PM | Report abuse

"well, this is going to be a long, hard ride."

where is bette davis when you need her?
if she had a taser in congress,
we would have had health care reform by now!

Posted by: jkaren | June 3, 2009 12:13 PM | Report abuse

I wouldn't be surprised if all the recent economic analyses weren't what flipped the administration. I'd bet the cost savings curve was a lot less attractive without the public plan. And without the cost savings the whole reform effort fails.

Posted by: flory | June 3, 2009 12:41 PM | Report abuse

The bargaining chip wasn't the public plan, it was the threat of filibuster by the marginal senators. The administration threw that chip out the window when they gathered the necessary support for passing reform through reconciliation. It just happens that by forcing the Democrats to go to the mattresses, the Republicans opened up whole new vistas of possible legislation. Once you only need 51 votes, the legislation can include all sorts of provisions that would never get even 55 votes, let alone 60.

Another dynamic at work is that the marginal senators like Nelson, Specter, Snowe, Collins, etc. keep demonstrating that they don't oppose anything on principle. Trying to extract concessions and then folding when it doesn't work won't make the White House back off--quite the opposite, in fact.

Posted by: extensive_vamping | June 3, 2009 2:22 PM | Report abuse

Don't be too quick to write off the states.

Connecticut Governor M. Jodi Rell will soon receive on her desk a bill passed overwhelmingly by our state House and Senate called "SustiNet." It sets up a public plan that is more inclusive AND more sustainable than any of the public options being discussed in DC right now. You can learn more about it at

Also, check out Gov. Rell’s new health care reform video at:

Here in the Nutmeg State, we've got momentum for landmark reform legislation!

Posted by: iBlogWestHartford | June 3, 2009 3:28 PM | Report abuse

I've never experienced the reality where Government involvement reduces costs. When has a public option ever worked effectively? Look at public transit in the early 20th century. City Government's took over private transit providers to lower costs and the public ended up with lower quality transit at a higher cost. Look at what the public options of Fannie and Freddie in mortgage finance have done to the housing market. Can anyone actually argue that that was a good idea? Look at Medicare and Medicaid and the VA system. It's estimated that Medicare and Medicaid lose up to 100 billion dollars/year to fraudulent claims because of poor oversight and an inefficient bureaucracy and the VA system can't even provide our wounded soldiers with rat free hospital rooms. Why on earth would anyone want to continue this trend of gross failure?

And if you think a public option is better because it wouldn't have a profit motive then watch the youtube video of Milton Friedman talking with Donahue about greed. I can't say it better than that.

Posted by: fallsmeadjc | June 3, 2009 10:21 PM | Report abuse

Seems to me the best strategy is to stay positive with regard to Ben Nelson. Let's welcome him back into the fold, thank him for his support. Let's not attack him for flip-flops until he goes back to opposing the public plan. Which will hopefully be never. :)

Any physicians out there interested in getting involved in this issue, there's a new organization called the National Physicians Alliance. We're in favor of sensible reform and a public health insurance option.

Check us out at

Posted by: cpage1 | June 4, 2009 3:06 PM | Report abuse

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