Why Health Reform Is Likely to Have a Public Plan

Huffington Post's Ryan Grim has been doing great work covering Sen. Ben Nelson's (D-Neb.) endless flips and flops on the public health insurance plan. A few weeks ago, you might remember that Nelson was talking about forming a "coalition of like-minded centrists opposed to the creation of a public plan, as a counterweight to Democrats pushing for it." Back then, the public plan was a "deal breaker."

Now? He's open to a public plan. Neat how that works. But Nelson isn't alone. Support for the public plan seems to have elevated in a few corners. Max Baucus (D-Mont.), previously cool to the idea, is now said to be fighting "tooth and nail" for its inclusion. Sen. Arlen Specter (D-Pa.), once a monosyllabic opponent ("no"), is now proclaiming himself open to the idea.

Meanwhile, the public plan's supporter -- Sens. Chuck Schumer (D-N.Y.), Ted Kennedy (D-Mass.), and others -- have organized and begun insisting, rather than merely mentioning, the idea. Liberal senators came together and signed a letter in support of the policy. The White House, which seemed relatively unsinterested in the issue a few months ago, has begun pushing hard for it.

And that, in my reporting, is what seems to be underneath the change. A few months ago, most observers thought the public plan was a bargaining chip. It had a lot of public supporters but few real friends. In recent weeks, that's begun to change. The White House seems genuinely intent on including a public plan -- or at least some form of public competition -- in the final bill. And that's changed the incentives for senators down the line. The public plan was safe to oppose so long as the powerful players weren't really interested in its survival. Indeed, when the policy was going to be bargained away anyway, the incentives were to try to convince the health industry that you'd been their key ally in that victory. But now that the White House has put some muscle behind the policy, opposition has potential consequences. And that's making the policy's opponents rethink their stridency.

A few months ago, I would have bet against the presence of a public plan in the final bill. Now I'd put my money in favor of it.

(Photo credit: AP Photo/Charles Dharapak)