Jon Cohn makes an important point that I think all the smart health care writers are making—the presence or absence of a public option isn’t the only thing that matters in the health care debate. There are a lot of moving pieces to this puzzle, and things like how much subsidies are available to people to buy insurance, what do we do with Medicaid eligibility, what kind of minimum benefits package will people have, etc. are also crucial.
That said, I think there’s actually a pretty good reason for activists to be putting a lot of emphasis on the public option. Things like subsidy levels and eligibility points and the details of benefits packages are the kind of thing that, if health reform passes this year, are bound to get tweaked over and over again in subsequent years. The long-run trajectory of these matters is going to depend more on who wins elections, on the state of the overall budgetary picture, on the idiosyncratic desires of power members of congress, etc., than it will on what the initial starting point is.
The public option’s not like that. A well-designed robust public option will, if implemented, become an enduring feature of the landscape that’s unlikely to vanish. By contrast, if a major reform is implemented and doesn’t include a public option, it’s extremely unlikely that the kind of coalition that’s currently pushing for one will be reassembled any time soon. On other stuff, in other words, we can always come back for another bite at the apple. But for the public option, it’s probably now or never.