On Tuesday, I linked to reports of a poll showing majority support for a public insurance option in health reform but wrote that I'd feel more confident if I could find the exact language. Happily, a helpful source came through and pointed out that the results were downloadable at the HCAN web site. And indeed they are.The poll was conducted by Lake Research Partners and it tests reactions to the public insurance option seven ways to Sunday. It asks whether the public insurance option "will have an unfair competitive advantage over private insurance because the government will set rules that favor the public plan" and suggests that "a new public health insurance plan will reimburse doctors and hospitals at much lower rates, causing many doctors and hospitals to shift higher costs onto people who buy private health insurance." It dangles that "a public health insurance plan will be another big, government bureaucracy that will increase costs to taxpayers" and warns that it might "force people into lower quality care including long waiting times and rationing of care."It doesn't matter. In case after case after case, the public insurance option retains majority support. And the reason why probably comes in another question from the same poll. Lake Research asked "do you favor or oppose providing access to affordable, quality health care for all Americans even if it means a major role for the federal government?" The preference for federal involvement was overwhelming:
The argument against the public insurance alternative is a bankshot: It requires making the case not against a government-run health care system, but against a government-run insurance option within a private health care system. Relying on mistrust of the feds is not, then, sufficient. You have to conjure such mistrust that the voters fear any federal foothold. And right now, that's not the mood. It's the private market, not the public sector, that's in disrepute. Assessing the politics as they stand now, the survival of the public insurance option will really be a question of whether the outside or inside game dominates health reform. If Congress builds its policy around public preferences, or fears public disappointment if there's a totally private insurance market, you'll see a public option. If it builds its policy around navigating the existing fault lines in Washington, then getting to 60 will require the deletion of the public insurance option.
The argument against the public insurance alternative is a bankshot: It requires making the case not against a government-run health care system, but against a government-run insurance option within a private health care system. Relying on mistrust of the feds is not, then, sufficient. You have to conjure such mistrust that the voters fear any federal foothold. And right now, that's not the mood. It's the private market, not the public sector, that's in disrepute. Assessing the politics as they stand now, the survival of the public insurance option will really be a question of whether the outside or inside game dominates health reform. If Congress builds its policy around public preferences, or fears public disappointment if there's a totally private insurance market, you'll see a public option. If it builds its policy around navigating the existing fault lines in Washington, then getting to 60 will require the deletion of the public insurance option. 
