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The Politics Of The Public Option

Just as it dominated the debate this summer, the public option has reemerged as the most-discussed provision in the Democrats' effort to reform the nation's health care system. Beginning with a closed-door meeting last Tuesday night between officials from the Senate and White House, legislative momentum seems to be building in its favor. That Senate Majority Leader Harry Reid (D-Nevada) and the Senate Democratic leadership appear ready to write a public option into their final bill is a huge victory unto itself (this because it would require 60 votes to strip the provision from the compromise bill on the floor). The New Republic's Jonathan Cohn posted a helpful breakdown of the various moving parts Friday morning.  This insight is the key takeaway: "The debate isn't over whether to include a public option," he wrote. "It's over what kind."

Now, to the specifics. On the House side, Speaker Nancy Pelosi (D-California) reportedly gave members of her caucus two main options in a meeting late last week: pass a bill with a government-run plan that either reimburses doctors at five percent more than Medicare rates or that negotiates reimbursement levels with providers. The former version, which Pelosi favors, would likely save about $60 billion over 10 years, according to previous projections from the Congressional Budget Office. Politico reports that the speaker does not yet have enough support to pass that plan, but the whip count remains fluid.

In the other chamber, the discussion is focused on compromises. Today, Sen. Reid announced that the bill he will bring to the floor will include a public health insurance option that individual states could decline to participate in. Both politically and on the policy merits, this "opt-out" version is far superior to the "trigger option" favored by Sen. Olympia Snowe (R-ME), Sen. Kent Conrad's (D-ND) co-ops, or the opt-in public option. But "centrists," including Snowe, aren't too fond of it. It might take the White House's political muscle to nudge those reluctant votes along.  In the meantime, there's a good possibility that the provision could survive a cloture motion, even if 60 votes aren't yet secured. (Josh Marshall has more background on the "opt-out.")

Meanwhile, 10th District congressional candidate Julie Hamos is circulating a petition in favor of a public option. Watch the accompanying video below:

Illinois Sen. Roland Burris has also continued his campaign for a government-run health plan on Public Radio International's The Tavis Smiley Show yesterday, insisting that he is "not going to be an obstructionist" but emphasizing that it will take a firm public option to garner his support. (The whole interview is available here.) If you want to explore the most likely outcomes, be sure to take a look at this two-dimensional schematic produced by FiveThirtyEight's Nate Silver.

Reform Advocates Keep Pushing

Across the country, activists are still pushing legislators to pass comprehensive reform this year. In Chicago on Friday, 80 members of the American Medical Student Association (AMSA) and Health Care for America Now protested what they called "the destructive actions of the privateinsurance industry" outside of the Blue Cross/Blue Shield Association headquarters. "As doctors, we want to spend our time discussing thebest treatments for our patients not on complicated insurance forms and convoluted regulations, or wrestling with insurance bureaucrats to get approval,” said Anthony Cheng, board member of the Northwestern School of Medicine Chapter of AMSA. And last Monday, interfaith leaders and Citizen Action/Illinois did their part by delivering roughly 2,000 petitions to Sen. Dick Durbin's office urging him to push for a robust public option as negotiations continue on Capitol Hill. Footage from a vigil they held before heading over to Durbin's office is available here.

The Geography Of Uninsurance

Illinoisans have reason to demand action. Using results of the Census Bureau's 2008 American Community Survey, National Journal's Ron Brownstein and Charlie Szymanski have put together a fascinating map charting the underinsured by congressional district. According to their research, many House members opposed to the reform effort actually represent districts with high uninsurance rates. In Illinois, the story is a bit different. A whopping 30 percent of residents in Rep. Luis Gutierrez' 4th District lack coverage, over 15 percent higher than the second highest district. All 13 districts with uninsurance rates above10 percent voted for Obama in the 2008 presidential race, while the three districts who swung for McCain (the 16th, 18th, and 19th) boast uninsurance rates just under 10 percent. Prairie State Blue has the full recap.

The data is enlightening for another reason, though: We so rarely see the number of uninsured presented as a percentage of the American population. While large numbers can be a bit misleading, it's hard to misinterpret the fact that one in seven of our fellow citizens can't receive preventative care or go to the doctor without fear of medical bankruptcy. That statistic is truly unsettling.