Oct 17 2009
David M. Herszenhorn
When House Democrats talk about the public option, there is no single definition of what that means. In fact, there could soon be three definitions.
The debate among Democrats over the public option -- a government-run insurance plan to compete with private insurers -- has mainly focused on two proposals. One is a ''robust'' plan, in which payments to doctors, hospitals and other providers would be tied to Medicare's rates. The other would require the government insurance program to negotiate its own payment rates.
But House leaders are now exploring a third approach: a public plan that would start out with negotiated rates but would have a fallback provision, or ''trigger,'' that would link the rates to Medicare if the plan was not saving enough money.
Compromise proposals are under consideration in the Senate as well, including one developed by Senator Thomas R. Carper, Democrat of Delaware, that would let individual states decide whether to create a public plan.
Meanwhile, some supporters of the public option, whatever form it may take, have warned that many people do not realize that a government-run plan generally would not be available as an alternative to existing employer-sponsored insurance.
In other words, it would be out of bounds to the approximately 160 million people already covered through employers.
Senator Ron Wyden, Democrat of Oregon, said that when he met with constituents over the summer, many were surprised to learn that a public plan would not be a choice for most of them. ''They nearly fell out of the bleachers,'' he said.