Public option supporters have taken a lot of heart from polling that indicates pretty widespread popularity for the idea of including a public option in health reform. But an interesting item from the NYT points out that this popularity masks something of an underlying indifference:
Two weeks ago, the Pew Research Center for the People and the Press asked respondents the main reason they either supported or opposed the health care bills. Among supporters, only 2 percent cited the public option. Among opponents, only 3 percent did so. [...]
For example, a nationwide Quinnipiac poll conducted shortly after the House passed its bill asked: “Do you support or oppose giving people the option of being covered by a government health insurance plan that would compete with private plans?” Fifty seven percent said they supported the option, while 35 were opposed.
I think this is a pretty rare instance of the broad public actually being closer to the mark than political activists. You could imagine a version of the public option—one that would pay Medicare rates and one whose patients providers would have to accept if they also wanted to accept Medicare clients—making a huge difference in the American health care system. Unfortunately, that idea had tragically little support in congress. Consequently the public option got defined down to something that’s much less significant.
At this point, the most important question determining the quality of the health insurance options that will be available to Americans in the future probably has to do with the design and implementation of insurance exchanges. The Senate contemplates this being done on a state-by-state basis, with the House contemplating a much larger state role. State government’s record as a regulator is, I think, quite poor. And the quality of insurance available to people over the long-run is going to be mostly determined by the quality of Exchange regulation. Do it the Senate’s way and residents of many states are going to end up with pretty lousy insurance, with the regulatory bodies mostly run by insurance companies. Do it the House’s way, and the outcome will probably be much better.