Is Today the Public Option's Last Chance?

For people on both sides of the health care reform war, the battle to create a public option is a ground zero. For conservatives, a government-run insurance plan means slouching toward socialism. For liberals, it's the only thing that can provide affordable care for millions of Americans and bargain down costs at the same time. (To others in the middle, the benefits of a government run plan are entirely overblown.) Today the Senate Finance Committee will take up the public option in its markup of the health care bill. What should we expect?

Joshua Green has an excellent overview at the Atlantic Wire. The main story isn't the war between Republicans and Democrats, but the civil war within the Democratic ranks. Still, he seems to suggest, today won't be so much the conclusive Appomattox of the public option war, but rather the Gettysburg -- an inflection point that could boost liberal Democrats' morale if they see the plan's defenders standing ground in the trenches.

Sen. Jay Rockefeller, the main public option's general, is expected to lead the charge for a couple public option amendments to Max Baucus' bill, which currently allows for only state-by-state co-ops. Republican Olympia Snow could also introduce a public option "trigger" amendment. That would allow the government to create public options within states if private insurance companies fail to provide affordable or comprehensive coverage. But truly, nobody really expects the public option to make its way into the Baucus bill today.

One of the central struggles I see with including a public option is between (1) Congress' instinct is to be incremental and (2) a successful public option has to be big. The CBO estimates that by 2019, the public plan in the House might enroll 10 million Americans if it extended to employers with 50 employees. That's not going to give it much leverage to push prices down. In fact it bends the cost curve up. It will be interesting to see how the Senate's amendments differ.