It's not a big surprise that the Senate has rejected efforts to include a public option in its version of health care reform. The deliberative pace of this deliberative body is legendary, and trying new ideas isn't really their cup of tea. Yet as some analysts remind us (in this case, Gail Russell Chaddock of the Christian Science Monitor), the vote was closer than expected, and it's too early to write the obit. What the public option really needs, it seems, is a good health insurance plan to keep it alive while the House and Senate conference on whether to pull the plug on it.
Actually, rather than pull the plug, we'd better freeze it and wait for advances in cryogenics to make it live again in a decade or so, because one thing seems increasingly evident to me: If we don't put the public option - or a public role - in the mix now, we will have to do so in future.
T.R. Reid's study of health care systems around the world, The Healing of America (see right margin), still one of the most revealing things I've read on the health care issue, makes amply clear that even for health care systems far more inclusive, inexpensive, and effective than ours (that's effectively all of them) there is no successful system that leaves health care pricing strictly to the private sector. That's true even in the German and Swiss systems, which rely on private insurance companies but which regulate the prices of most basic and essential medical services. (The private companies make most of their profits by selling ancillary policies covering optional procedures.)
The major cost difference between health care in the U.S. and in other countries (even though ours covers fewer of us and drops us when we need it) is profit. Other factors contribute (costs of drug research and testing, malpractice insurance, unnecessary tests, etc.) of course, but not enough to account for the extra 6-7% of GDP we pay compared to France, Germany, or Japan. What Reid's book proves is that we stand little chance of controlling the growth of costs without government involvement, either as an insurance/care provider, or as a regulator of costs. Granted, the Senate (and Congress in general) has never excelled in tasks requiring far-sightedness; but if there's no sense of urgency at the moment, there will come a time, perhaps when our health expenditures reach 25%, or 30%, of our total spending, that we'll be forced to address the issue of cost.
Incrementalism sometimes is the only way to get things done, but it carries a cost. If we wait, the price of fixing things later will be far more than if we do it now, and the resources expended in the interim will have been wasted.