Health-care reform in America

Democrats are trying to revive the idea of a government-run health plan

“IT’S not really a public option, it’s a consumer option.” So declared Nancy Pelosi, speaker of the House of Representatives, this week. Her effort to rebrand the hugely controversial proposal to add a government-run insurer (usually called a “public plan”) to the health reforms now being negotiated seems ridiculous at first blush. In fact, it is part of a concerted and clever push by the political left that could—just possibly—revive an idea that had seemed dead and buried.

When Mrs Pelosi revealed, on October 29th, the House’s version of a health-reform bill, there were no real suprises; as expected, a public plan featured prominently. The real suprise had come three days earlier. Until very recently, it had looked as though the proposal to tack on a public plan was, despite fervent support among the left, politically doomed. First came Barack Obama’s slippery but clear efforts to back away from it. Then came a crucial vote of the Senate Finance Committee, which rejected the public plan. The final congressional health bill must reconcile the versions coming out of the full House and Senate, and the powerful Finance Committee’s rejection had appeared to be a final nail in the coffin.

But this week Harry Reid, the leader of the Senate Democrats and an ardent fan of the proposal, dropped a bombshell. During the process of reconciling the output of the Senate’s Health and Finance Committees, he overruled the wishes of the latter. So the health bill that the full Senate is likely to consider over the next few weeks now looks likely to include a public plan.

In an effort to win over as many sceptics as possible, though, Mr Reid has circumscribed his public plan in several ways. First, only a minority of Americans (essentially, those without employer-provided coverage) would be eligible. Second, the plan is forbidden from dictating that hospitals accept the same low reimbursement rates given by Medicare, the government scheme for the elderly. Most important, though, is that individual states would be allowed to opt out.

Though leftists groused that this was too weak a proposal, the news buoyed the spirits of public-plan advocates in the House. Many conservative Democrats there (including the “Blue Dog” coalition) and moderates from conservative districts are reluctant to cast a vote for any final House bill with the public plan without cover from the Senate: their vote would be in vain, but they would still get pummelled by Republicans back at home for supporting the plan. Anthony Weiner, a liberal congressman from New York, gushes that “Reid was worth 15 votes!”

Perhaps, but it is too early to say whether Mr Reid’s gamble was bold or reckless. That is because it has offended moderates in both chambers. As Mrs Pelosi scrambles to put together a majority of 218 votes in the House, it is too early to say whether the 15 votes she supposedly picked up this week were offset by many more refuseniks. A caucus meeting of House Democrats this week gave an indicator that the latter might be true. Rumours swirled that efforts to promote a “strong version” of the public plan (one which would tie reimbursement rates to Medicare) failed to garner sufficient support in the House.

Mr Reid’s gambit has also offended several important moderates in the Senate, who are now considering dropping all support for the health reform effort, which might still deprive the Democrats of the 60 votes they need for normal passage of a bill. This is a grave matter, as Mr Obama has indicated that he would like health reform to pass without resorting to a hugely provocative procedure known as budget reconciliation, which would require only 50 votes.

One senator with his nose out of joint is Joe Lieberman of Connecticut who is now officially an independent but who still caucuses with the Democrats. He said this week that he cannot vote for any Senate bill that contains a public plan. Similar noises were made by Olympia Snowe of Maine, the lone Republican to vote for the bill passing out of the Senate’s finance committee. There are at least three other wavering Democrats in the Senate—Louisiana’s Mary Landrieu, Arkansas’s Blanche Lincoln and Nebraska’s Ben Nelson—who all, unsurprisingly, come from states that voted for John McCain in the last presidential election.

Whether a public plan will prevail or not is anyone’s guess. A strong version has no chance of passing both chambers, but it is now possible that some lesser version could end up on Mr Obama’s desk for signature. He himself has advocated a compromise version that would be triggered only after a few years, and only if private competition failed to achieve affordable universal cover. That plan, which the courageous (and now snubbed) Ms Snowe also supports, may yet emerge at the eleventh hour as a compromise. The only thing that can be said with certainty is that a proposal that seemed close to death is now alive and kicking.

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Full article and photo: http://www.economist.com/world/unitedstates/displayStory.cfm?story_id=14754722&source=features_box3