If you're looking for the coming fault line on the left of health care politics, keep an eye on what happens to the public insurance option in the health reform bill. Access to a public insurer is a big deal for progressives and conservatives alike. It's important to progressives because they believe a public insurer -- which is to say, an insurer that's not concerned with the profit motive -- could offer better coverage at lower cost, and in doing, attract more customers and pave the way to something closer to a single payer system. It's important to conservatives for the exact same reason. The only difference is that progressives think this a very good thing that cannot be sacrificed while conservatives think this a very bad thing that cannot be allowed. Cue the fine reporters at Congressional Quarterly:
Republicans also debated whether one aspect of Obama's health care proposal, giving people the option of buying a public health care plan, would weaken the private insurance market.Mark Hayes, a Republican health policy adviser to the Senate Finance Committee, said Republicans have concerns because the government plan might have access to price controls and other tools not available to private insurers. This could lead to lower premiums in the government plan, which would cause most consumers to migrate out of the private market, he said."Over time the effect the government option could have [is an] erosion in the private market, [making] other choices not available," Hayes said.Calling this government-backed plan one of the "radioactive fault lines" that has developed in discussions on the overhaul, McDonough suggested Democrats would be willing to look at other options."What is the purpose behind the proposal? The purpose . . . is [public plans are] one of the most important devices out there to provide cost accountability," McDonough said. "Maybe there are other way to achieve those ends."
McDonough is John McDonough, Ted Kennedy's senior health adviser. My sense has long been that the public insurer stood a good chance of dying once the legislative horse trading got underway, but it's surprising to hear that expressed so early.
