The buzz in the blogosphere since the end of last week was all about the fate of the public option in health reform. The question seemed to be shaping up not as “Will there be a public option?” but rather “What will the public option look like?” Last Thursday, Ezra Klein posted a quick guide outlining the options over the public option. There’s the “trigger option” favored heavily by moderate Republican Olympia Snowe, the “opt-in option” introduced by Democrat Tom Carper, and the “opt-out option,” which is essentially Democrat Chuck Schumer’s careful reframing of Carper’s proposal.
In every way this is an issue of political and technical feasibility. That is to say, which approach can actually get the public option through with enough Congressional support, and what will each option look like when it comes time for it to be implemented? In case you couldn’t guess, the two (political and technical feasibility) don’t exactly travel together. Here’s my graphical explanation of how it all works out, with heavy acknowledgment to both Ezra Klein and Jonathan Cohn.
The House is bringing the robust public option to the table. That’s old news. What the Senate bill will look like when Harry Reid finishes the “mash-up” of his bill with Max Baucus’ contribution is the big question, because Reid’s HELP effort has a public option and Baucus’ Finance bill does not. It matters for many reasons, not the least of which is it represents the Senate’s starting point for potential negotiations with the House during conference. If both the House and Senate bills include some type of public option, it looks like a done deal that health reform will include some variant of a government plan. Thus, all the hype.
Well, on Monday afternoon, Sen. Reid held a press conference and announced that the Senate bill would include a public option. Specifically, he outlined a version that would create a single federal plan and permit states to opt-out of participating if they chose. The demonstrated principle behind requiring opt-out rather than opt-in is one of inertia. For instance, studies have shown that more drivers are registered as organ donors in states where the default option is to donate rather than not to donate.
It’s simple really: people are generally unlikely to take action unless they feel very strongly about something. So, by changing the default category, you essentially move the more apathetic people into the group to which you’d like them to belong, but you’ve not in any way limited their freedom of choice. You’ve merely capitalized on human nature. The hope for Reid’s public option opt-out is that states work similarly to people. I’m guessing that they will. Besides, history shows us that even with opt-in programs, like Medicaid, all states eventually decide to participate.
In sum, I think Monday’s announcement is fantastic news. Of course, Olympia Snowe–whose vote was so coveted just a week ago–is adamantly opposed to the inclusion of the public option. But I have two thoughts on that. First, she’s just one vote, and as symbolic as that may be, it’s still just one vote. Second, it goes to show you how quickly the tide can turn in this debate. A week or so ago, everything was about the trigger option and bending over backwards to get Snowe to vote for Baucus’ bill. Now, it’s about the opt-out option and it doesn’t matter if Snowe supports it or not. So, on second thought, I’ll hedge my bets. Monday’s fantastic news is fantastic news for now. In the meantime, I’m not holding my breath.