The health care reform debate appears to be narrowing down. That's good because the time is near for U.S. House and U.S. Senate to begin floor debate on the most important legislation of the year. It's also bad, because if consensus can't be found on the final issue, the whole idea of health care reform just won't be done anytime soon.
The sticking point is over whether health care reform should include a government-run health insurance plan, a so-called public opt-in plan.
Senate Majority Leader Harry Reid, D-Nev., paved the way in recent days by pledging some kind of opt-in plan as part of the Senate package to be sent to the floor. His compromise - making the opt-in plan also an opt-out plan. In other words, the government-run health insurance plan would become available nationally, but states would have the authority to "opt out" of the plan.
On the surface, the concept should satisfy constitutional Republicans who claim the 10th Amendment to the U.S. Constitution leaves to the states any matter not specifically granted to the federal government in the Constitution.
They claim the Constitution has no provisions for federal government health insurance, so the compromise leaving that decision to participate up to the states should agree with that position.
Still, the idea remains unsettling to Republicans as well as some Democrats. Key is Independent Sen. Joe Lieberman of Connecticut, who's vote is needed to reach 60 votes to move the bill to the Senate floor.
Hopefully, a compromise can be reached as major health care reform is now a necessity. And controlling rising insurance premiums is as much a concern as is controlling rising medical costs. The two are inseparable.
Having government intrude itself into the private insurance industry is troubling, but we already have Medicare and veterans health care through the Veterans Administration. Sen. Thomas Carper, D-Del., a member of the Senate Finance Committee, is proposing instead that any public option be run by a non-profit board, rather than the government, and that it not be funded through taxpayer dollars.
Forming a "public" cooperative to provide pooled health insurance could work. In a way, that's how the VA is set up, which has the authority to negotiate drug prices with pharmaceutical companies -- something that Medicare can't do.
The House, meanwhile, seems to be forming around mandatory health insurance for all, or else pay a fine. That seems the most disruptive and intrusive and should not advance.
The bottom line is we're so close, we shouldn't drop the ball now. There may not be another chance this decade.