Public option: Do not resuscitate?

THE REIGNING CLICHE of the health-care debate so far:

"Don't let the perfect be the enemy of the good."

Scratch that. Substitute: "Don't let the good be the enemy of the so-so."

Reports of a health-care compromise in the Senate may be exaggerated. Several of the 10 senators who reportedly made a deal now claim that they merely sent the elements of a possible agreement to the Congressional Budget Office to determine the costs.

But in comments to reporters yesterday that were about as subtle as a buzz saw, House Speaker Nancy Pelosi signaled that Democratic leaders have all but abandoned the "public option." And some exhausted reform advocates are arguing that the Senate compromise would be better than a watered-down public option. Notice the theme?

Yet, even though - to indulge in the debate's runner-up cliché - "the devil is in the details," there may be less reform here than meets the eye.

The two main elements of a possible Senate deal are fairly clear: a private, nonprofit insurance option administered by the same office that runs the federal employees' insurance plan and an opportunity for people 55 and older to buy in to Medicare.

Some liberals are chortling that, by expanding Medicare to a younger age group, senators would open the door for single-payer insurance, which is what we really need. "Medicare for all" has long been the single-payer rallying cry. But allowing people to "buy in" to Medicare is not the same as "expanding" Medicare coverage so that younger people get the same coverage at the same cost as today's seniors. Instead, it's entirely possible that under-65 consumers would pay much higher premiums - AARP estimates the cost at $7,600 a year for an individual. Government subsidies wouldn't make up much of the cost. Besides, millions of Americans under 55 wouldn't be eligible for the offer because of their age, even as they will be forced to buy private insurance or face a fine.

The Senate bill's second element would dump the public option for a scheme in which the Office of Personnel Management - the federal agency that handles insurance for the government's employees - would negotiate with private insurance companies to offer nonprofit plans to individuals not covered by employers.

Since OPM administers the federal employees' health plans, it sounds as if uninsured Americans would have the same access to health care as members of Congress. But they probably would get substantially less. The federal employees' plan covers up to 87 percent of health-care costs, but the plan offered under reform would pay in the neighborhood of 70 percent.

OPM doesn't have a good track record of controlling costs. And, like for-profit insurance, private nonprofit plans also pay exorbitant executive salaries and high administrative costs.

Health reform without a public option would mean tighter regulations and increased subsidies, real benefits for consumers, but it also would lack the kind of competition that would start to reshape the broken health-care system.

DEMOCRATS MAY HAVE caved, but many progressive reform advocates have not. A large majority of Americans continue to want a government-run alternative to private health insurance. Last summer, when the public option was declared DOA, their phone-call, e-mail, and TV-ad assault on Congress and the White House revived it.

Could it happen again? To use another cliché:

Yes it can.