The public option has stalled. So what now?

By Michael J.W. Stickings

Sen. Tom Harkin thinks he has the votes to pass a health-care reform package that includes a so-called "public option," and he may very well be right -- it's possible, if (and it's a huge if) Democrats pull together to break an expected Republican filibuster) -- but, as of right now, the public option has stalled in the Senate Finance Committee, which, despite a Democratic majority voted today against two separate proposals put forward by Sens. Chuck Schumer and Jay Rockefeller. The problem is not so much that the Republicans all voted against them (including Schumer's compromise), it's that so many Democrats did, including Committee Chairman Max Baucus, who delusionally continues to push for a bipartisan package (without a public option) even with almost all Republicans clearly opposed to any and all compromise. (As Steve Benen notes, the Republican arguments against the public option were predictably stupid.)

We have long known that the Republicans are against meaningful health-care reform. What is so annoying now, though, is that the main obstacle is Democratic opposition in the Senate, from Baucus and Kent Conrad and so on. It is a small bloc of centrists, but it is a bloc that could side with the GOP on a filibuster (in refusing to break it, even against the wishes of an overwhelming majority of fellow Democrats).

So what now?

Well, Democrats could, and should, still push for the inclusion of a robust public option in any reform package. All it not lost yet.

And yet, as many health-care experts have pointed out, quite persuasively, you may not need a public option to achieve some of key goals of reform. And there is one country, as TNR's Jonathan Cohn writes, that is a model of how to do it: The Netherlands:

Liberals, understandably, are in agony. But they can take at least some comfort in looking overseas -- where one tiny country has managed to build a popular and successful universal health care program based entirely on private insurance. That country is the Netherlands, which several years ago overhauled its health care system and achieved most of the goals the liberal reform movement holds dear: near-universal coverage, affordable insurance, and quality health care.

Under the new system, the Dutch government has required that everybody gets insurance; in return, it makes sure insurance is available to everybody, regardless of pre-existing medical conditions or income. Although the government finances long-term care through a public program, it has turned over the job of providing basic medical coverage exclusively to private insurers, including some for-profit companies. Surveys show that the Dutch are happier with their health care than are Americans -- or the people of any other developed country, for that matter.

The "catch," as Cohn notes, is that health care in the Netherlands, however private, "operates more or less like a public utility."

Read the whole piece. It's an interesting model, and a viable alternative, though perhaps unworkable in the U.S., given the general reluctance to reform industry as vigorously as would be required. Still, with the public option in trouble, and with the distinct possibility that whatever reform package is passed will not include it, it may be time to start looking for next-best approaches, if we haven't already, that would, at the very least, be steps in the right direction and that could, eventually, lead to the sort of universal public system many of us desire.