Buoyed by polls showing support for a public option or "paid Medicare" rising, some Democrats are threatening to grow backbones over the issue.
While the Senate Finance Committee yesterday rejected two attempts to add a public option, the competing bill of the HELP Committee does contain one, and a floor fight over the issue appears likely.
New HELP Committee chair Sen. Tom Harkin of Iowa (right) insists his side has the votes to prevail on the floor.
Partly as a result, Republicans have stepped up their rhetoric on social issues that might kill reform, specifically immigration and abortion. The President has indicated he might firm up language on the former, despite deep liberal misgivings, but Republicans lost a test vote on abortion.
Four committees in Congress cover the subject of health reform, three have reported, and all three include a public option. Once the Finance Committee mark-up is done, the Senate leadership will have to decide whether or not to include it in a bill they send to the floor.
Chances of a public option passing are better if it's in the floor bill. Since a public option is a financial question, it might be subject to reconciliation, passing with a simple majority. If it's not in the leadership bill, it would have to be added by amendment, and that debate could clearly be subject to a cloture vote of 60 Senators. (Without Sen. Robert Byrd, Democrats have 59.)
Two public option amendments were offered in the Finance Committee. One lost five Democrats, the other lost three. That amendment, by Sen. Charles Schumer of New York, did not tie reimbursement rates under the option to those paid by Medicare. It could be brought into the leadership bill.
Business has two competing interests here. Buyers of insurance and services want lower prices. Sellers want no guarantee of that, although insurers do face market pressure to fight inflation, and their own programs to automate and use comparative effectiveness data may someday work to that end.
Most businessmen I know are ideologically inclined toward conservatism, but when their own interests are on the line all bets are off. I have written here consistently that business' interests will settle this debate, and that remains the case.