Over the next few years, health reform will succeed or fail based on a few major flashpoints that will shape any new program, including the financing of health insurance and the access to medical care itself. This is the first of a series of occasional posts that will explore these flashpoints, and how the media is explaining them to the public.

It’s no secret that the sine qua non of Barack Obama’s health care plan is under attack—the creation of a public option, a Medicare-like plan with the government providing the benefits. Such a plan would be open to people who don’t have coverage now, and maybe even to those who do. They may want to switch into what could be a cheaper and more comprehensive plan if given an option to do so, and that scares the devil out of insurance companies. Their products might become uncompetitive if the public comes to believe there’s a different route to better coverage. The frontal assault has yet to begin, but combatants are moving their troops in position.

We hope the media recognize this and quickly steer away from what has become their favorite story of the last few weeks—that health chief Tom Daschle should avoid Hillary Clinton’s mistakes. Instead, they should focus on the coming battle, which will decide the future of health care in the U.S. for years to come. We offer a little background for a reporter’s clip search.

Ezra Klein over at The American Prospect’s blog was right on point last week when he sent along some ominous news. Klein, quoting a story in Congressional Quarterly, said that John McDonough, the former head of a Massachusetts advocacy group who now works for Ted Kennedy, seemed to be backpedaling on the public option:

Calling this government-backed plan one of the “radioactive fault lines” that has developed in discussions on the overhaul, McDonough suggested Democrats would be willing to look at other options. “What is the purpose behind the proposal? The purpose…is [public plans are] one of the most important devices out there to provide cost accountability,” McDonough said. “Maybe there are other ways to achieve those ends.”


Klein wrote that he had thought the public option might die once legislative wrangling began, but he was surprised to hear that it might disappear so soon. Right-wing think tanks, which often provide the intellectual ammunition for the special interests, are also on the march. The Heritage Foundation released two reports this month. One, a Web Memo, struck at the heart of Daschle’s plan to have a federal health board recommend new technologies, drugs, and treatments that may be more effective and less expensive than ones commonly in use. Heritage health policy guru Robert Moffit argued that a powerful board plus a “controlled” market dominated by a government health plan would end existing private coverage for people and “ensure unprecedented government interference in the delivery of care.” Heritage uber health guru Stuart Butler made similar arguments in a Washington Times op-ed on Thursday. Such thinking is likely to seep into mainstream reporting.

The advocacy community is worried. It sees the public plan as an essential element of reform—a bridge, perhaps, to a single-payer system that would cover all Americans as a matter of right. The Institute for America’s Future, which is part of the liberal Campaign for America’s Future, gathered reporters on a conference call last week to push the virtues of a public insurance option, with Berkeley political science professor Jacob Hacker making the case.

The most telling news from the call came from Rep. Pete Stark, chair of the House Ways and Means health subcommittee. Stark, who was on the phone, told reporters that, without a public plan, reform might be ineffective. Then he delivered this message: Congress is likely to take a slower approach to health reform; voting on comprehensive reform wouldn’t happen until early 2010, because Congress has too many pressing priorities, such as the economy, and smaller-scale health care issues, like reauthorizing the State Children’s Health Insurance Program (SCHIP). He also said he had to give everybody a hearing, especially the American Medical Association, the American Hospital Association, and big PhRMA, all of which are likely to oppose a public plan for different reasons.

As for the insurance industry, Stark said, “They’re going to be easy to roll because nobody likes insurance companies.” It’s not likely AHIP, the insurers’ trade group, will let that happen, and it has begun to mobilize its own grassroots supporters, who can be counted on to tell Congress they like private insurance just fine.

And there you have it, the battle map for a public plan. It all should make for make for some interesting copy. ABC News began to get it with a reasonable story about the press conference. We will be watching to see if other media outlets do the same.

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Trudy Lieberman is a fellow at the Center for Advancing Health and a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR’s healthcare desk, which is part of our United States Project on the coverage of politics and policy. Follow her on Twitter @Trudy_Lieberman.