doctor For the life of me, I cannot imagine how the Liberals in Congress–particularly in the Senate–can possibly get a health care reform bill passed that includes a public option of any kind. Can you?

Just do the math. In the far more liberal House, health care reform passed by the slimmest of majorities. In the Senate–where cobbling together a 60-vote majority is like herding cats–Majority Leader Harry Reid somehow managed to get 60 senators to agree to begin debate on his draft bill this week.

But getting a final bill passed by both Houses and on to President Barack Obama's desk is another story. There are a handful of conservative Democrats in the Senate who insist they will not vote for a bill with a public option. Therefore, no such provision can survive–not even with a clever but transparent opt-out for individual states slipped into the Senate draft.

Everyone knows that few state legislatures and governors will have the political nerve to deny their constituents the right to buy from a public insurance plan if one is available.

Right now, it is easy for state officials to take shots at a health care reform plan being debated in faraway Washington, but including a state opt-out provision makes the debate local and very personal. Local elections can be won or lost on such pocketbook issues, so an opt-out provision is likely dead on arrival, in my humble opinion.

Liberals in Congress saw health care reform as an opportunity to pretty much eliminate the private insurance industry and, at worst, gradually install a public insurance plan in its place. It is clear that is not going to happen–unless the “fine” for failing to buy coverage is so pitifully small that insurers are forced to cover millions only after they become seriously ill.

Is the loss of any public option enough to make Liberals reject health care reform outright? Republicans would like to think so–hoping that if Liberals cannot live with a public option-free bill, they will withhold their vote on principle.

I wouldn't count on that. While Liberals may have seen their dreams of “Medicare For All” shattered, I cannot imagine they will walk away from the table this time empty handed–not with their party in control of the White House, and with midterm elections perhaps threatening their stranglehold on Congress. They may never have a better chance to pass a reform bill this sweeping in its scope.

Better to live to fight another day. Get a bill passed that prohibits rejection by insurers due to preexisting conditions, sets restrictions over rating and mandates the purchase of coverage for most. Set up exchanges where individuals and small businesses can buy coverage, while providing subsidies for those who cannot afford insurance.

That's a pretty radical departure from the status quo. If premiums remain unaffordable, and if President Obama wins a second term, Democrats can revisit the public option. Given that the bill does not fully take effect until after the next presidential election, you can count on the that.

What do you folks think?

Special Reports /

Public Health Option Is Dead On Arrival

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