Neuron Culture

1. The tireless, and occasionally tiresome, advocacy on behalf of liberal bloggers and interest groups for the public option. Whatever you think of their tactics -- I haven't always agreed with them -- the sheer amount of focus and energy expended on their behalf has been very important, keeping the issue alive in the public debate.

2. The fact that the CBO thinks it will save money.

3. The seeming inevitability of health care reform, which neuters the voices of those who aren't opposed to the public option per se so much as the entire project of health care reform.

4. The fact that the locus of power has shifted from the Gang of Six -- Bingaman/Conrad/Baucus/Snowe/Grassley/Enzi to the Group of Six -- Pelosi/Dodd/Obama/Reid/Baucus/Snowe.

5. The "innovation" of the opt-in/opt-out family of compromises, which have more liberal "street cred" than co-ops or triggers and are potentially also much more politically advantageous.

6. The fading from memory of the tea party protests and the "government takeover" meme.

There are four more -- I didn't want to steal the thing outright, so you should follow the link below. Also of interest is Aaron E. Carroll's HuffPo piece on why, even as a single-payer advocate, he feels the public option is less than vital. His valid point is that the option doesn't necessarily provide coverage to more people than other measures do. But I think he downplays one important aspect and misses another. First, he says that it'll save only about $110 billion over 10 years. We need to save more -- but that's plenty of reason to include a public option. And he misses altogether the other reason people want a public option: It will, symbolically at least, declare that coverage of everyone is a direct public good and even obligation, just as Medicare establishes that we agree we'll look after the elderly. This has not just symbolic significance but long-term political and policy significance. And it gives people (and potentialy companies, down the line) at least the chance to vote with their feet and their wallets for whether they want private insurance or a government payer to look after their insurance money. These are less than feel-good issues. . That said, a public option runs a risk of collecting just the highest-risk, most heavily subsidized part of the risk pool. You can call that a zero-sum game, I suppose, if you figure those people will be insured anyway (as they should be) in a heavily subsidized, take-everybody private market. But on the books, it'll weigh heavily on public monies and look like more a loser than it really is: the public option market would bleed while the private market would gather the healthier, wealthier customers and look healthier than ever. Which could in turn be used as an argument against public solutions.