Health reform realities

In the free-wheeling, even abrasive, debate over health-care reform nothing is more contentious than enacting a government-run insurance plan.

Democrats, including President Obama, promote the idea, modeled after the popular Medicare program, as a way of providing reasonably priced coverage while fostering competition with private insurers.

Conservatives and the insurance companies loathe the idea, which they see as a stalking horse for establishment of a single-payer plan, similar to Canada's. That prospect fuels the rage of protesters, railing about a government takeover of the health insurance industry.
Despite the vehement rhetoric, it's unclear whether a government-run plan would be the boon or bust that each side foresees. Unless the option were subsidized by taxes, which even Senate supporters have largely dismissed, it would likely gain little traction in the marketplace, already dominated by large insurers that in some states have virtually monopolies.

While Obama has touted the idea as a way to keep insurance companies "honest," he's also portrayed it as a only a "sliver" of the necessary reforms, which include covering the uninsured, holding down costs and ending predatory insurance practices.

Significantly, both he and Kathleen Sebelius, the secretary of health and human services, have signaled that the public option is not an essential element of reform. She instead raised the alternative of insurance co-ops, an approach popular in the Midwest and among some Republicans although their viability is largely untested.

The political realities, especially in the more conservative Senate, virtually doom inclusion of a government-run insurance plan in any comprehensive health-reform package. More liberal Democrats may grouse, but they will likely have to sacrifice their pet plan to achieve the greater goal of providing universal coverage and insurance reform.