Why the Public Option Isn't Dispensable

Health reform may not work without it.

By Timothy Noah
Posted Monday, Aug. 17, 2009, at 7:07 PM ET

---

Speculation is rife that the White House will cut loose the "public option"—i.e., the creation of a government health-insurance program to compete against private insurers. The signals aren't new; I began worrying about this nearly six months ago. (See "Is Obama Soft on Health Insurance?") The political mainstream seems to be greeting the latest hints from Health and Human Services Secretary Kathleen Sebelius and others with its usual shrug that politics is the art of the possible; to make a deal, all sides may have to give something up. The trouble in this instance is that political pragmatism conflicts with programmatic pragmatism. Without a public option, there's a very real danger that health reform simply won't work. It might even make things worse.

If the public option gets dropped, the likely reason won't be a lack of commitment in the White House so much as a lack of votes in the Senate. A recent count from the liberal blogger Chris Bowers indicates 43 senators are prepared to vote in favor. That's seven votes shy of the necessary 50 (Vice President Joe Biden being the tiebreaker) if we assume health care reform passes as a "reconciliation" bill not subject to filibuster. If the reconciliation route is averted, it's 17 votes shy of a filibuster-proof majority. Nate Silver, the numbers-crunching blogger at FiveThirtyEight, knocks Bowers' public-option count down to 41, in part because it's doubtful that the gravely ill Sen. Edward Kennedy, D-Mass., will live past the Labor Day recess. On the other hand, Kennedy's death might stir some recalcitrant Democrats to honor his legacy by supporting the public option. (It's worth remembering that a Kennedy death, admittedly under more gruesome and tragic circumstances, helped create Medicare and Medicaid back in 1965.)