A "weak public option" may be a myth

There's a recent post over at Blue Oregon about whether or not a "weak public option" is better than none and whether its worth fighting for.  The post has lead to a lot of feedback, currently 68 comments.  The thing is that I'm not convinced this is even a debate worth having.  I've made my belief that a strong public option is necessary pretty clear, but lets go back and look at what a strong public option (as opposed to a weak one) actually entails.  University of California Public Policy Professor, Jacob Hacker examined three crucial provisions (sorry, this file seems to have disappeared from the internet) that he argued make the difference between a good public plan and a not so good public plan.  Those three provisions were:

(1) a "Medicare tie-in" that allows the public plan to develop a broad national provider network with competitive payment rates quickly, (2) the creation of a national excahnge that can give a wide range of firms, as well as uninsured Americans, access to both the public plan and regulated private insurance options, and (3) providing the public plan with enough authority to reduce medical inflation through drug-price bargaining and innovations in the financing and delivery of care.

According to Hacker all three of the bills contain some elements of a "strong public option," but all have some problems.  For example the House Energy and Commerce Committee bill fails to set its imbursement rates to Medicare allowing providers to negotiate independently with the public plan under threat of opting out if they don't pay more than Medicare does, this would obviously drive up costs.

There are two things on my mind considering the question of whether a weak public option is better than no public option at all.

To begin with, health care reform does not stop with this fight, it will inevitably be tinkered with in the future.  With that in mind however, it will be extremely unlikely for a program passed now to be abandoned, once we create programs we really don't like to get rid of them.  So a weak public plan could someday become a strong public option.  I think the far greater risk comes from no public option at all where the American taxpayers end up footing the bill for subsidies that benefit insurance companies without any competitive pressure to bring costs down, I'm sure insurance companies would just love to have 50 million new customers financed by the Federal Government.  A weak public option on the other hand still has some bargaining and cost control power, just not as much as it should have.

Secondly, I don't think there's a lot to be gained by weakening a public plan.  I have a hard time imagining that the strength of a public plan as opposed to its very existence, is a deal breaker for many (or any) Democrats in Congress.  I'm sure various members have preferences on these matters, but I doubt that anyone whose vote is necessary will withhold their vote because the public plan is too strong, more likely they oppose the public option, period.  I don't know how those whip counts would look, but the scenario under which a public option is acceptable to members whose votes are needed, but a strong one is unacceptable just doesn't seem plausible to me.

The far more dangerous possibility is that a trigger will be inserted into the bill, this is merely a means of destroying the public option, the trigger will never get sprung, though I have little doubt that the conditions that allow it to be put into place will arise.  On the question of whether or not to accept a "weak public option," however, I think the answer is clearly that a strong public option should be fought for, but it can be strengthened in the future and if it must be weakened in order to pass, then that should be supported.  The worst possible outcome is no public option at all, and that's what we should be fighting to avoid.