Senate - What to do about public option?

No doubt there are significant differences between the two committees who have produced healthcare bills in the Senate, but the big issue that tears at the roots of ideology, is the "public option."

Listening to moderate Democrats, they're clearly looking, plain and simple, for a way out.  They could stomach one - perhaps something trimmed down or one that kicks in at some point -- the so-called "trigger" -- but it better not look like the one proposed by Sen. Jay Rockefeller, D-WV.

Rockefeller is, no doubt, a true believer. He wants the government to run a Medicaid-based system that reimburses providers at Medicare levels of reimbursement.  Problem is, it won't get off the ground with the more conservative members of the Dem Caucus, and certainly not Dems from less-populated states like North Dakota.  Sen. Kent Conrad, D-ND, says his hospitals would go belly-up with the low levels of reimbursement --- so that option has got to be out, if you look at the math.  There's no way for Majority Leader Reid to get to 60.

So -- then you look at Sen. Tom Carper's compromise.  Some in Democratic leadership and Administration circles  clearly like this plan, though there are various versions that give some more conservative Dems a headache.

The Delaware Dem hasn't shown any concrete language, so you have to go by what aides are saying and descriptions from the senator.  It allows, at its core, states to make the decision on whether to create some form of public option and/or, cooperatives.

But - some want to create a national plan under the Carper proposal. You could either "opt in" as a state -- if current reforms aren't working - OR - the government could create a national plan that all states must enter, and then they can "opt out."

Carper, being a former governor, likes the idea of giving power to the states, but he seems a little skeptical of the "opt-in, opt-out" options.

Privately, Democratic leadership aides admit that much of the focus is on Maine's senior senator, Olympia Snowe, who became the only Republican to vote for a healthcare bill -- the one out of the Finance Committee Tuesday.

Snowe supports a so-called "trigger" as a fall back plan where some form of a public option kicks in, perhaps temporarily, if reforms do not bring health care costs down.  The same leadership aides say that it is increasingly likely that the "trigger" gets into the base bill that Reid is now crafting.

Oh -- and Snowe does not like the Carper proposal.  Carper plans to meet with her to sell her, so we'll see.  (Some reports said he met with her Wednesday night. Not true. He attended a funeral in Delaware. He's only spoken briefly with her off the Senate floor. A more in-depth meeting is still to come - or at least Carper wants one.)

All the other public option proposals will have to wait for floor action in the form of amendments. That might not be Reid's preference, to hear him at today's weekly stakeout. The leader said, "I believe in a public option, but remember: I said, 'I do.'"

But that's not the final word, of course. This healthcare debate changes at a rather rapid speed.

Clearly, Reid has his work cut out for him.

Remember those moderates?

A bipartisan group of them has been meeting on the sidelines, in various gatherings, many concerned about rising deficits and making healthcare more affordable without onerous government involvement.  It seems clear that this group, and perhaps another that includes many of the moderate freshmen (who also happen to be largely moderate), are wrestling with ways to improve (from their standpoint) the bill.

Sen. Evan Bayh, D-IN, has said he is meeting with some fellow moderates to discuss ways in which the revenue-raising mechanisms in any healthcare bill can be set in stone.  He doubts that Congress has the stomach for future Medicare cuts, for instance.

Bayh met with President Obama for a half hour on Wednesday, and afterward issued a statement that called for "an independent debt-fighting panel." He and nine of his colleagues signed onto a letter to Reid that noted, "Each citizen’s share of today’s debt is more than $38,000...The bigger our deficits, the fewer resources we have to provide critical investments in energy, education and health care and tax relief for small businesses and middle-class families."

Sen. Ben Nelson, D-NE, said, "There are a lot of moving parts...Not enough has been done to bend the cost curve." And of the Snowe trigger, which hints at a possible compromise for Reid, Nelson said, "The trigger is not something that would cause me to not be supportive."  Nelson met with Snowe earlier Thursday.

Sen. Mary Landrieu, D-LA, said, "I'm looking for full and complete transparency before the floor debate. Number two, cost containment on the floor debate. And increase in choices and options, because I beleive one way to reform the healthcare market is to increase choice."

Landrieu is for "interstate exchanges" for cross-state purchasing of healthcare plans.

Sen. Mark Pryor, D-AR, seems a bit more amenable to compromise, but again, there is an as-yet-unknown caveat, a familiar refrain that you get from most moderates who don't want to close the door on reform. "Public option is not a deal breaker for me. It depends on how it's structured. It depends on what's in there and how it really works. I've heard a lot of variations on it...I loook forward to seeing what Harry Reid puts in there that he thinks he can get 60 votes on."

That certainly is the $6 million question these days....