The New Health Dialogue

The ongoing debate over whether health reform should include a public health insurance plan is beginning to remind us of an all too familiar exercise in hard choices—deciding where to go to lunch with your co-workers.

It starts out so simple. You and your co-workers want to go out to lunch. You all agree that lunch is a good thing, a necessary thing. The status quo of hunger and boredom just cannot continue.

But where to go?

One person suggests the Greek deli across the street. It's tasty, it's fast and the guy behind the counter wears that awesome fisherman's hat. But it's sort of expensive, and so another co-worker suggests the sandwich place around the corner. Alas, you had that yesterday and the line looks long. So you say "How about burgers?" and your vegan friend looks at you like you've just suggested eating a newborn baby.

And so it goes.

Every new suggestion brings another three counter proposals. Things seem like they'll never end. Then, somehow, a consensus is reached, plans are made and half an hour later you're enjoying a roast beef on rye, while your vegan friend happily munches on something that looks like cardboard topped with lettuce.

Asking someone if they support a public health insurance option is kind of like asking them if they want tacos for lunch. It all depends on what kind of establishment you're talking about. Taco Bell? Well, that gives some people indigestion (We think there's no better vehicle for caloric consumption than a crunchwrap supreme). Baja Fresh? They've won more than a few over with their fish tacos. What about Chipotle? Qdoba? California Tortilla? We could (and do) go on and on.

Sometimes tthe menu choices can be tough.The New York Times reported earlier that the AMA had come out in opposition to a public health insurance option. The AMA then clarified its position, stressing its commitment to health reform and its openness to compromise on the public plan. We expect President Obama to elaborate on those compromises when he addresses the AMA next Monday. The incident incident illustrates what director of the White House Office of Health Reform, Nancy-Ann DeParle—who will be speaking at Friday's Health CEOs for Health Reform event—noted was a common theme in her conversations with lawmakers—a person's position on offering a public health insurance option generally depended on how they defined the nature of that option. Some, like Senator Rockefeller, favor a plan based off Medicare payment rates. Others, like Senator Schumer have pushed for a public health insurance option designed to compete on a level playing field with private plans. Senator Conrad's proposal for insurance co-ops has also drawn bipartisan interest.

The important thing to remember is that this is just one component within the broader health reform debate. It's important to consider our options, but this debate should not be allowed to derail the entire reform process. We can live with the standard lunch routine, but the status quo is no longer acceptable for health care.