Congress hasn't yet begun the lengthy process of bargaining out the differences between House and Senate on the actual formula for health-care legislation. But, miracle of miracles, the Democratic majorities in both chambers now seem committed to inclusion of a so-called public option. What that phrase means is not that the government will "take over" health care, as various Republicans and tea-partiers maintain. Nor will the public option, as proposed, come anywhere close to being the single-payer system — aka "Medicare for everybody" — that some liberals have insisted on.
It's more akin to a downscale equivalent of the U.S. Postal Service, existing more as a last resort than as serious competition for the entrenched health-insurance companies. Just as the Postal Service has been no threat to FedEx and UPS, whatever minimal alternative the federal government would establish by way of a basic insurance option would hardly endanger Blue Cross/Blue Shield, Humana, or the rest of the big boys in the health-insurance field.
What it might do is A) provide an additional incentive for those companies to improve their business models; and B) be something of a brake on skyrocketing costs. And that's all it is meant to do.
As unveiled on Monday by Democratic majority leader Harry Reid, the Senate's version will contain a further reassurance to sincere conservatives with legitimate concerns about the erosion of barriers between the private and public realms (though it is hard for us to imagine what could be more legitimately "public" than making universally available the means for a healthy citizenry).
As currently proposed, the Senate bill would allow states to opt out of the public option if they chose. Presumably, other, less controversial aspects of the legislation — guaranteed portability, elimination of restrictions on pre-existing conditions, and the like — would still apply everywhere. What's the catch? There is none. All those ideologues who have conjured up the phantasms of "death panels," physician scarcity, and inferior "socialized" medical care could see the issue put to a fair test.
Which brings us to the subject of what course Tennessee would take if confronted with an opt-out provision. Democratic hopes to the contrary notwithstanding, every indication is that the electoral trends will continue that have already resulted in Republican majorities in both houses of the Tennessee legislature.
Most members of the state's Republican establishment have long embraced the benefits of the Tennessee Valley Authority, once ritually denounced as "creeping socialism." Poor, underfunded states like ours are exactly the sort that benefit from the variety of "public options" made available by the federal government. (An ironic feature of the health-care protests held in these parts last summer was the number of participants who owned up to having benefited from Medicare.)
Sometime within the next calendar year, the GOP-dominated Tennessee General Assembly may well have the opportunity to choose between ideological purity and clear advantage to the state's citizens in the matter of health care. We believe candidates for the legislature and, for that matter, those running for governor have a duty to make their positions clear on the matter.