Obamacare

Public Option II: Public Optioner?

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Are we set for a sequel to last year's debate about the "public option"—a government-run insurance plan that liberal members of Congress and the progressive base wanted added to the PPACA? Ultimately, the provision was given up in a bargaining manuever by Democratic leadership and the Obama administration, but The Washington Post reports that 128 House Democrats are trying, once again, to light the public option fire:

At a time when both political parties are worrying about the federal deficit, an unexpected and unorthodox proposal is coming back from the shadows of last year's health-care debate the "public option." The idea of creating a major government health insurance program was roundly rejected last year, but the 128 House Democrats pushing to reconsider the idea are now advancing the argument that it would help hold down federal spending.

Their bill, which faces long odds, would allow Americans who do not get insurance at work to choose a government plan for their health coverage starting in 2014.

"There is all this concern about the deficit," said Rep. Lynn Woolsey, D-Calif., a leading champion of the proposal. "Well, guess what, this would reduce the deficit because it saves so much money." Woolsey and her allies, including Reps. Jan Schakowsky of Illinois and Fortney "Pete" Stark of California, are armed with a new analysis by the nonpartisan Congressional Budget Office. It projects the public option could save the federal government $68 billion between 2014 an 2020, according to Democrats.

There are two things going on here. The first is that there really are a lot of liberals, both in the House and within the activist base, who remain deeply upset over the health care bill's failure to include a government-run insurance program. That core liberal group is going to take every opportunity they can to raise the subject. The primary thing that's going on here, though, is that many Democrats are eager to needle Republicans about the deficit. It's a game of pick-which-is-worse: Republicans have been loudly worrying over the deficit recently (though without supporting any particular deficit-reduction mechanisms), and Democrats want to put the GOP in the position of having to choose between their worries over the deficit and their hatred of government-run health insurance.

In other words, this isn't a serious attempt to reignite the public option debate, especially since Democratic leadership is probably not keen to start the health care battle again so close to the elections. But that doesn't mean that the public option is dead forever. As Rep. Henry Waxman, who chairs the House Energy and Commerce Committee, noted in April, the idea will definitely come back should the PPACA's insurance exchanges fail to produce the desired results. Given the troubles Massachusetts has had with its insurance market in the wake of its health care overhaul—and, in particular, given the significant premium spikes we've seen in the state—I suspect that it won't take long after the exchanges are put in place for Democrats to revisit the issue. But the on-switch for the exchanges won't be flipped until 2014, which means that the public option fight is destined to be a long one. In the meantime, what we're seeing is mostly just petty political gamesmanship.