updated 8/28/2009 3:37:06 PM ET 2009-08-28T19:37:06

For congressional Democrats trying to make President Obama’s campaign promise come true, this is pick-your-poison time.

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A public option — viewed by conservatives as a “Washington takeover of health care” — can’t survive the Senate, and the House can’t seemingly pass a health care bill without one.

It’s a choice fraught with risk, and with real consequences, both politically and substantively.

One of the things that makes it so interesting to watch is the way conservative ideologues have so effectively demonized the federal government, and by association Medicare. It reveals just how little Americans know about Medicare that so many see it as a government-run health program.

That’s not exactly the way Medicare works.

Basically, the federal government establishes a benefit package for Medicare’s 40 million seniors, and also sets the rates at which doctors, hospitals, nursing homes and medical device makers are paid, and then also investigates fraud complaints or patient mistreatment, such as in nursing homes.

That’s all the feds do. Medicare’s day-to-day administration is handled by health insurance carriers, as contractors. But listen to Democrats and you’d think that Medicare or a public option as proposed would involve legions of caring, altruistic civil servants manning those toll-free customer service lines and processing provider payments.

Hate to break it to you, but they’re actually employees of – yeesh, here goes – insurance companies or their subsidiaries.

For example, Noridian Administrative Services in Fargo, N.D., handles Medicare claims and payments to health care providers in a dozen States. Aetna, Cigna and Humana also make the Medicare trains run on time.

But listen to congressional liberals and you’d think a public option will be a government-run program, when in fact it most certainly would rely on government contractors, namely insurance companies, to fully function.

No wonder the public is dazed and confused.

Democrats shouldn’t demonize health insurance firms at the same time they rely on those same demons to run Medicare, their ‘government-run’ ideal, and presumably to handle their heralded public option too. Thanks to this lack of candor, the public largely believes Medicare is solely a government-run program, when in reality it is not.

That said, it’s also true that a public option would save about $150 billion over the next ten years — roughly $1,100 for every taxpayer, according to the Congressional Budget Office (CBO) official estimate. The CBO also reports that employer-based coverage would increase under the pending House health measure.

Surely the conservative ‘Blue Dog Democrats’ in the House would want to think twice before joining House Republicans in throwing a public option overboard. The health care coverage of 10 million to 12 million Americans is at stake with this decision.

Most Americans receive health insurance through their employer, and they’re generally happy with it. But they know costs are increasing at three times the rate of wage increases over the past decade.

What they hear from Democrats is that the government is the only answer, when in reality the profit motive in health care is retained in both pending House and Senate measures. When will Democrats acknowledge that fact?

And, for their part, conservatives should cage their dogma and acknowledge their long-held support for “socialized medicine.” For the record, the only purely socialized medicine that involves the federal government is provided by the Veterans Administration and the Department of Defense. If you served in military combat, or are on active military duty, you can receive your health care from a federal employee at a government hospital, and on the American taxpayer’s dime.

Oh, and let’s not forget the federal Bureau of Prisons either, since thanks to the Constitution prisoners are the only Americans guaranteed free health care coverage.

Or what to make of the 2003 Medicare Part D prescription drug program proposed by President Bush and which passed Congress with almost Republican-only support. Roughly 24 million elderly, or nearly 60 percent of seniors (the rest have employer-based coverage), choose to opt in to “Medicare’s greatest expansion since its inception in 1965” which is projected to cost taxpayers nearly $400 billion over the next decade.

Then there’s the Bush Administration’s doubling the number and cost of community health centers serving the uninsured working poor. Or Republicans’ support for billions of taxpayer dollars for the state-based children’s health insurance program , which covers 7.4 million children under age 19.

Do Republicans seek to privatize government-provided health care to our veterans, the military, seniors, or the working poor and their children? Of course not. They simply want government to take its hands off the health care they themselves created — “just say no

Never before has sausage-making killed so many brain cells of politicians from both political parties. Democrats forget to mention the true role of health insurance firms in their ‘public option,’ and Republicans can’t remember their true role in recent major expansions of government-run health care programs. Let’s all hope the Senate Finance Committee’s bipartisan “Gang of Six” plan includes amnesia as a covered benefit.

As Rep. Jim Cooper, D-Tenn., a leading Blue Dog and influential player in health care, told CNN, “So many advocates of public option don’t really know specifically what they’re advocating and so many opponents don’t really know what they’re opposing. So it’s important that we get the definition right.”

John Edgell is a former Democratic congressional staffer.

CQ © 2009 All Rights Reserved | Congressional Quarterly Inc. 1255 22nd Street N.W. Washington, D.C. 20037 | 202-419-8500


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