High-Stakes Health Reform

Senate Majority Leader Harry Reid grew up 50 miles outside the gaming capital of the world and sparred as an amateur boxer during his teen years. Perhaps this upbringing explains the Nevada politician's urge to take up the risky fight for a public option in the health-care reform bill that will soon come to the Senate floor. In some ways, Reid's willingness to play hardball is a new development for timid, risk-averse Senate Democrats, who have been caught playing defense on an issue that they should own.

Meanwhile, House Democrats unveiled their own bill on Thursday, which includes a public health-insurance option that allows states to opt out and generally matches Reid's promised legislation. What comes next is a new round of attacks from opponents about how "ObamaCare" will ruin the American way of life. That strategy hasn't worked yet, and it's unlikely to succeed at this late stage -- more and more Americans support the idea of a public option, and they're increasingly aware that its existence may not affect them at all.

Given all the political capital expended in this battle so far, it is clear that one side or the other is making a huge political miscalculation on how health-care reform will play with voters next year. It may be that seven-card-stud Harry Reid and the liberal Democrats -- currently dancing in the aisles at the decision to push for the public option -- are completely misreading the public mood. Otherwise, it is the town hall Republicans -- having tied their political future to defeating a public option -- who are going down the wrong rabbit hole by trying to paint the health-care overhaul as another reckless, Democratic expansion of government that would rob Americans of their rightful freedoms.

In the middle of this skirmish is the skittish wing of the Democratic Party. Senators like Ben Nelson, Mary Landrieu, and Blanche Lincoln have bought into the GOP's line of reasoning and are now wracked with worry that a public option will cost them politically.

The debate is now framed in epic terms: The most intrusive government intervention ever versus the creation of a system that finally decouples access to health care from one's economic station in life. For those on the losing side, the political consequences could be dire. The mistake may be so monumental that it could take a few generations to recover -- think Depression-era conservatives on Social Security.

Of course, if I had to guess today, I would say that it looks like Republicans will shower themselves in opprobrium this time around, with a special consideration for those Democrats too scared to have this fight.

The public option, in whatever form it ultimately emerges, will permanently change the way we think about health care if enacted. Its repeated death and resurrection during the course of the debate serves as a telltale coda to the odd politics of bluster and distortion of the Bush years. The Republican opposition to health-care reform has been dogged over the last few months, but the rationale for that opposition -- like the rationale for the war in Iraq -- has kept shifting over time. First, the American public was to fret over the dangers of interventionist Big Government. Then came talk of death panels. Then, the creeping advance of socialism became the concern. When all those arguments began to fray without derailing legislation, Republicans suggested to the administration that they scrap the whole plan and start over; that failed, too. The only successful diversion was the rallying of summer town halls, when we saw a brief return of what seemed like genuine populist American anger. Support for the president and his plan started to wane, and it looked like health care might be dead. The White House said the public option was a negotiable item and looked weak giving this conciliation.

But Republicans, it turned out, had little more than angry faces to offer to the debate, and now they have retreated considerably. There is currently almost no question about the passage of a health-care bill in some form. The battle lines are drawn, and discussion has shifted from the feasibility to reform to the specifics of what reform should look like -- and, for Republicans, whether to filibuster a bill that includes a public option.

Those are the real questions being asked now. Reid has taken some heat, mostly from moderate and conservative Democrats, for his decision to bring a bill to the floor without the votes to guarantee passage. But Reid may understand better than most that this may be the moment to take a few chances, even if the odds are long. It's called gambling.