What a week with health care

For those of use who do not normally follow health care issues, it's been an eye-opening experience, to say the least, to keep track of all the various plans leaking out of Capitol Hill at a record pace.

It's clear that health care reform will live or die in the Senate, so it's helpful to focus on that body only, for now.

Democrats are clearly wrestling with whether or not they can, indeed, keep a presidential campaign promise to provide a government-run health care option.  Some Democrats are saying the votes are simply not there.

Anything difficult in the Senate needs 60 votes to overcome a filibuster, and a "public option" - or government-run plan - would certainly run headlong into one.

Moderate Democrats are not supportive of it, and Republicans hear nothing but "single payer health insurance" when anyone even mentions "public option." They immediately start saying things like, "Democrats just want to put the government between you and your doctor."

Since we have not seen actual language, it's hard to know if that's true.  President Obama and Democratic leaders are insistent on one thing, "If you like the plan you have now, you get to keep it."  And they seem adamant that the cost of health care come down.

If longtime universal health care proponent Sen. Ted Kennedy, D-MA, venerable chairman of the Health, Education, Labor, and Pensions Committee were here, this might be a different fight.  Kennedy has just started another round of chemo, though, as he battles brain cancer, and though he participates by phone in much of the debate, Kennedy, in person, is a force.  He is a liberal lion, but he has worked over the  years with many Republicans, and he is trusted.

But for now, Democrats are working on a compromise that appears as if it will fall short of a government-run health plan ---- though it might allow Dems to say the government has its nose under the tent, while Republicans can say the government is NOT running things.

Enter moderate Sen. Kent Conrad, D-ND.

He has a plan Fox has reported on that would create cooperatives. Those in urban and rural areas have heard of them.  You city folk have them controlling apartment/condo buildings.  You farm state/rural folk have them controlling all kinds of things -- like your power and water.

Conrad envisions a similar thing for health insurance, with the government possibly setting up the program and infusing it, initially, with enough money to compete, but eventually bowing out.  Conrad cites the government's initial efforts to set up HMO's.

The Conrad cooperative would be a nonprofit, funded and run by consumers.  You would have it on a menu of options, just like many people get now through their employer.

Congress will likely create massive health care exchanges, kind of like the travel website Orvitz, where you type in what you want and a list of competing plans and prices pops up.  Shopping at your fingertips.

To those on the left who feel this is a betrayal, a ditching of the public option, Conrad says this, "What is the whole purpose of public option? The purpose is to have a competing delivery model to go out and go up against for-profit insurance companies. This cooperative model provides that.  Yes,  is not government controlled, it is not government run, but if you try to get something that is government controlled, government run there are virtually no Republicans that will support it and some Democrats that won't, which means you probably can't get 60votes ."

Conrad says proponents of the public option cannot let the perfect be the enemy of the good, essentially, asking, "Do you really want to jeopardize health care reform that is so urgently needed to cover 46 million people that don't have coverage? "

And on Friday, one influential senior Senate Democrat, Jack Reed, D-RI, a member of Kennedy's committee, introduced a proposal that could provide an infrastructure upon which a Conrad cooperatives plan could be built.

Reed would use "federally qualified community health centers" that now exist in eight states across the nation to provide "non-profit Community Health Plans" that would compete with private insurers.   These could be cooperatives, according to a Reed spokesman.

Conrad said giving up the public option is what's needed in difficult economic times, with the very solvency of the U.S. government at stake  with a health care system that is dysfunctional.  It remains to be seen if more liberal Democrats would sign on, though.

Still, Conrad asks, "Look what is at stake here is enormous for the country, and if we can accomplish the really good things about a public option without it being government controlled, why not?"