It's Back (Maybe)

President Obama's health reform is chugging along, moving closer to a full debate in both chambers of Congress.

So, it's time to reintroduce a highly controversial subject: the public option. Insurers, big business, and angry shouters at town-hall meetings all hate it. It was left for dead after nearly derailing the whole reform effort. But in the weeks since I and almost everyone else pronounced the Democrats' public-option idea deceased, no one's come up with a viable alternative plan to insure tens of millions of Americans who don't have health care.

The Senate Finance Committee bill that's expected to pass next week is seen as a blueprint for a final reform proposal. It has no public option and instead calls for the formation of nonprofit co-ops to compete with private insurers. It's an idea that diffuses a time bomb but doesn't solve a problem. In the process, its alienated liberal Democrats.

"There is going to be something you can refer to as a public option," says Kenneth Bowler, executive vice president of Dow Lohnes Government Strategies, which lobbies for a number of companies, including biotech firm Amgen Inc.

Bowler, a longtime congressional staffer and Washington lobbyist, thinks some sort of trigger that allows states to decide whether to create a public option will have the best chance of winning over both liberal and moderate Democrats, giving the party bosses their best chance of passage.

He's not alone in his thinking. The top exec for the largest doctors' lobbying group, the American Medical Association (AMA), last week told a forum sponsored by William Blair & Co. in Chicago that it's too early to write off the public option.

"Nothing is really in or out: The conference committee is where a lot of action is going to take place," AMA chief executive Michael Maves told the audience, referring to the process when the House and Senate negotiators meet to merge their bills into one.

Once the Senate Finance Committee bill moves to the Senate floor, it will be inundated with hundreds of amendments, including public-option proposals. It's the last of five bills (three in the House, two in the Senate) that has yet to pass out of committee.

Even with a public option added, Bowler gives health reform slightly better than 50-50 chance of passing all the way through Congress, which he says are much better odds than Bill Clinton faced 15 years ago. "Maybe the chance now is 51 percent," he says.