Stephen Crowley/The New York Times

There’s more than one option when it comes to the public option.

The Senate Finance Committee on Tuesday debated and voted down two amendments that were meant to add a government-run health insurance plan to the major health care legislation. The first, offered by Senator John D. Rockefeller IV, Democrat of West Virginia, was defeated around 3 p.m. The second, by Senator Charles E. Schumer, Democrat of New York, was voted down about an hour later.

The defeats had been expected, and both Senators were really looking beyond the committee for a chance to have the full Senate consider a public option.

Senators Rockefeller and Schumer are allies in the effort to create a public plan to compete with private insurers. But the differences between their proposals highlight a point that is often overlooked in the health care debate: there are lots of different ways to structure a government-run health plan.



Stephen Crowley/The New York Times



While Republicans denounce all proposals for a public plan, Democrats who support the idea disagree sharply over the best ways to design it — and in some cases individual lawmakers have put forward multiple proposals in hopes of winning over colleagues.

Mr. Rockefeller, for instance, proposed a public option called the Consumer Choice Health Plan, which for the first two years would pay doctors, hospitals and other health care providers according to rates tied to Medicare, the government insurance program for Americans over 65 and for the disabled. In debate, Senator Kent Conrad, Democrat of North Dakota, said that such a public plan, tied to Medicare rates, would devastate hospitals in his home state. Under Mr. Rockefeller’s plan, the payment rates would be renegotiated after two years.

Mr. Schumer, by contrast, put forward an amendment calling for a public option with a “level playing field,” seeking to reassure Republicans that a public plan would not have unfair advantage over private insurers.

Mr. Schumer’s public plan would not predetermine the payment rates for providers, but would leave the payment rates to be negotiated later. Aides said the rates would be higher than what Medicare pays, but lower than current market rates.



Stephen Crowley/The New York Times

Mr. Rockefeller has also proposed another amendment, designed to look like the version of a public option included in legislation under consideration in the House. That proposal would base payment rates on Medicare for three years, but would pay a premium of 5 percent above Medicare rates for providers that also accept Medicare. (Not all health care providers accept the government insurance.)

There are other differences as well. Mr. Rockefeller’s first proposal would create a public plan to be run by a director appointed by the president and confirmed by the Senate. Other proposals would have the public plan run by the secretary of health and human services.

Mr. Schumer’s proposal, for instance, calls for the public plan to be offered in several tiers: basic, enhanced and premium, and also allows for a premium-plus plan.

Most of the public plan proposals bar the federal government from providing any additional financing for the insurance program beyond initial start-up costs, as a way of being sure that the government plan competes fairly with private insurers. But Mr. Rockefeller’s proposal would allow additional government support, provided that a super-majority of Congress (three-fifths in both the House and Senate) votes to approve the funding.

It’s not clear that any of these differences mattered much in the Finance Committee. There simply were not enough votes. But again, proponents of a public option are still hoping to have their ideas receive a fuller airing by the full Senate.