WASHINGTON -- Some of the biggest questions in President Obama's push for health care reform are over the creation of a "public option" to compete with private companies in the health insurance marketplace.
Whatever the phrase "public option" suggests to you when you hear it, Obama told the American Medical Association in Chicago on Monday that it is not "about socialized medicine and government takeovers, long lines and rationed care, decisions made by bureaucrats and not doctors."
Obama twice talked of socialized medicine in order to inoculate the public against one of the first lines of attack critics of a "public option" will use -- that it's socialism on U.S. soil.
No matter that Medicare -- a government-run subsidized health insurance program covering the nation's elderly and some disabled people -- is socialized medicine.
Now I can't tell you in this column exactly what the public option is going to be, because the main committees drafting health care legislation in the House and the Senate are still at work. Over in the House, a "discussion draft" with some details should be out, maybe, by next week. What I'll try to do here is give you some of the big picture.
Obama made the quick trip home Monday to make an expansive case before the AMA for changing the health care system. His arguments relied as much on macro economics -- escalating health costs are a "ticking time-bomb for the federal budget" -- as on improving individual medical care.
"Too many doctors and patients," Obama said, "are making decisions without the benefit of the latest research."
So we are learning a bit what the "public option" is not. It is not socialism and it is not universal coverage.
A "public option" form of heath insurance would be another offering in Obama's proposed Health Insurance Exchange. Explained Obama: "This exchange will allow you to one-stop shop for a health care plan, compare benefits and prices, and choose a plan that's best for you and your family -- the same way, by the way, that federal employees can do, from a postal worker to a member of Congress."
In discussing a "public option," Obama's message team is telling Democrats on Capitol Hill to avoid using the phrase "universal coverage" because that phrase is often associated with a single-payer system, which is often associated with "socialism," which the Obama administration does not support. The Obama team-approved language is instead to talk about "guaranteed health care," a phrase that is less polarizing.
"It is important for our reform efforts to build on our traditions here in the United States. So when you hear the naysayers claim that I'm trying to bring about government-run health care, know this: They're not telling the truth," Obama said.
That guarantee can come in many, many forms and will be the subject of much debate in the weeks ahead, as Obama is pressing for some preliminary votes on health care legislation this summer.
What Obama has always argued was that if you bring down costs and provide government subsidies, millions of uninsured people will buy policies -- motivated by common sense or mandate.
The main way to get the medical marketplace to cover more people -- even folks with expensive pre-existing conditions -- is to inject more competition into the system.
So a "public option" today is a guiding principle or concept and could end up being:
• • a co-op, much like a rural utility operating with government backing -- but not direct government management.
• • an expansion of the existing government-run Medicare program, a "Peoplecare" plan.
• • some government-sponsored nonprofit entity bankrolled by the federal government but run independently.
Or a player to be named later.