When House Speaker Nancy Pelosi (D-Calif.) told Bloomberg today that “it’s absolutely essential that we come out of this year with a substantial health-care reform,” and “the best prospect for that to happen is to do it under reconciliation” — the process by which legislation would only need 51 votes to pass, rather than the 60 votes ordinarily required to end debate — she was obliquely referring to what is fast emerging as the central issue in health care reform: the so-called “public plan.”

President Obama laid out  the idea in his “Open for Questions” online town hall Thursday.

If you’ve got a preexisting condition you’re not going to be excluded but you’re going to be able to obtain health insurance.  And if you can’t obtain it through a private plan then there is going to a public plan that is available in some way to give you insurance, or insurers are obligated to provide you with insurance in some way.

 Now that’s a principle.

It’s a principle that opponents of the strongest health care reform plans hate. While supportive of the general idea of expanding coverage, leaders of the  insurance and pharmaceutical industries stepped up their attacks on the public plan concept this week. It’s also why Howard Dean’s Democracy for America launched its health care reform campaign yesterday with the demand that the inclusion of a public plan in any upcoming health care legislation must be “non-negotiable.”

For Obama and sympathetic left-liberal policy wonks, the question is what form the public plan should take in order to insure congressional approval. Ezra Klein of the American Prospect sketched three options, while Harold Pollack, University of Chicago researcher and blogger for The New Republic, identified the central political reality:

“Among the many components of candidate Obama’s proposed healthcare plan, the public plan is the one most likely to be thrown under the bus in negotiations seeking a final bill.”

The public jockeying over the idea of packaging health care reform in a budget resolution that doesn’t require 60 votes for Senate consideration is the opening phase of these negotiations. With Sen. Charles Grassley (R-Iowa) opposed to a public plan, any reform package that includes it is unlikely to get 60 votes — but it might get 51. To put it another way, if Obama forgoes the reconciliation process in pursuing health care, the public plan is much more likely to go under the bus.

Source: washingtonindependent.com

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