Forget Harry Reid. His fifteen seconds of "fame" are over. Nancy Pelosi is the new heathcare reform It Pol, and she's thrown all her cards on the table: We need a "robust" public option in this bill.

The Politico reports:

Speaker Nancy Pelosi told Democrats Tuesday night that she wants to move forward with the more liberal version of a House health reform bill that would peg government-run coverage to Medicare ‚Äď setting up a clash with moderates in her caucus who oppose the plan.

Pelosi told her rank-and-file that she has more than 200 votes for a public option tethered to Medicare and that she wants to "see if we can find the remaining votes," one member present said afterward.

"We are very close and I count tough," Pelosi told the room, according to one person in the room. She asked Majority Whip James Clyburn (D-S.C.) to ask his deputies to survey members in the next 24 hours to see if she could get to 218 votes for the bill, several members said after the meeting.

According to preliminary numbers, the final bill being sought by Pelosi would cost an estimated $870 billion over the next 10 years - well under President Barack Obama's $900 billion target - and cover 96 percent of those Americans who qualify for coverage. The plan wouldn't add to the deficit over its first decade, but it's less clear whether it is deficit neutral in the second 10 years.

However, Matthew Yglesias points out that we (as a public) still aren't quite sure what a public option actually does, much less how it would benefit us:

This whole set-up is, frankly, too complicated to explain in a poll question. But according to the Post's poll, 57 percent of Americans say they would support "having the government create a new health-insurance plan to compete with private health-insurance plans." Of the 40 percent who are opposed, 45 percent say they would change their minds "if this government-sponsored plan was run by state governments and was available only to people who did not have a choice of affordable private insurance."

The preference for a state-run plan seems to evince a lack of understanding of the policy issues. This might work well enough for large states like California, Texas, and New York. But a program that insures only a relatively small fraction of the population of a small state like Vermont or Montana might be too small to be viable. Insurance needs scale to spread risk. What's more, state-based plans would, in most places at least, lack the leverage necessary to bargain effectively with providers, thus defeating one of the major motivations for creating a public option.

The business about limiting eligibility to people who don't have a choice of affordable private insurance suggests confusion on the part of the pollster. Under all proposals, people currently insured through their employers or existing government programs would be ineligible. At the same time, under all proposals everyone will be eligible for a level of subsidies designed to make insurance affordable. So this proposed modification to the plan would either change nothing, or else it would exclude absolutely everyone from the public plan. The question, in other words, doesn't really make sense. Most likely whoever put the question together was simply confused, and respondents just played along.

This is a reminder, most of all, that public opinion polls tend to be unreliable when unfamiliar questions are asked. The public, moreover, isn't composed of policy wonks. And the news sources most people rely on barely even try to explain policy specifics. Consequently, it would be exceedingly unwise for politicians to pay an undue amount of deference to poll results when outlining major policy measures. What will make health reform popular or unpopular at the end of the day will be whether or not people feel that it works for them. A public option should make reform work better, and that's the best reason-both politically and substantively-to include one.


Guess we'll find out those details a little later.

As Pelosi is stepping up her support for the public option, President Obama is deliberately stepping back:

After spending much of the summer and most of September banging his presidential drum in favor of a health care overhaul, Mr. Obama, entering what one senior White House official called "a quiet period," is intentionally lowering his public profile on the issue, for the moment.

The idea, aides said, is for the president to take a breather while Democrats resolve their internal conflicts, so he can come back strong with a fresh sales pitch when the legislation moves closer to floor votes. [...]

"He's been in very great danger of people hitting the mute button when he comes on television to talk about health care," said David Gergen, who has advised both Republican and Democratic presidents on communications strategy. "So I think it's wise to take a pause here and come back in full voice to make his case, because people are going to be more ready to listen again."


In the meantime, Democrats and Republicans are continuing to lob darts at one another. The Republicans are railroading plans to increase Medicare payments to doctors because there is no provision to offset the payments.

Senator Bob Corker, Republican of Tennessee, said, "I hope that there will be senators on both sides of the aisle who revolt at the majority leader's push to purchase the support of physicians by, in essence, creating legislation that puts our country another quarter-trillion dollars in debt."

Won't someone please think of kids like Deamonte? This isn't purchasing support of physicians, it's allowing them to see more people. Oh, the (lack of) humanity...


On the other side of the aisle, Democrats are striking fear into the hearts of insurance companies by examining their antitrust protection:

Top Senate Democrats intend to try to strip the health insurance industry of its exemption from federal antitrust laws, according to congressional officials, the latest evidence of a deepening struggle over President Barack Obama's effort to overhaul the health care industry.

If enacted, the switch would mean greater federal regulation for an industry that recently has stepped up its criticism of portions of a health care bill moving toward the Senate floor. [...]

In a statement, the major industry trade group, America's Health Insurance Plans, said the industry already was one of the most regulated in the country. The focus on the industry's antitrust exemption, it said, was "a political ploy designed to distract attention away from the real issue of rising health care costs."


In the midst of all this, Pelosi is still trying to cobble up the 218 votes she needs to push this bill through. Good luck with that, Madame. And let TLC be your guide.

Pelosi pushes strong public option [Politico]
What's the Public Option, Again? [The Daily Beast]

Obama Takes a Health Care Hiatus [NY Times]
Senate Democrats Hit Snag With Doctor Payment Bill [NY Times]
Remember Deamonte? [Washington Post]
Dems eye insurance industry's antitrust protection [AP]