Could the pragmatists win on health care?

I had a chance to skim the letter from the CBO to Harry Reid on the spending impact of Patient Protection and Affordable Care Act. While I won't claim to fully comprehend the numbers, I will say I was pleased to see the following discussion (on page 4) about the so called public option:

The options available in the insurance exchanges would include private health insurance plans and could also include a public plan that would be administered by the Secretary of Health and Human Services (HHS). The public plan would negotiate payment rates with all providers and suppliers of health care goods and services; providers would not be required to participate in the public plan in order to participate in Medicare. The public plan would have to charge premiums that covered its costs, including the costs of paying back start-up funding that the government would provide. State governments could elect not to make the public plan available in their state. The legislation also would provide start-up funds to encourage the creation of cooperative insurance plans (co-ops) that could be offered through the exchanges; existing insurers could not be approved as co-ops.

In other words, for the debates: Should there be a public option? and Should there be co-ops instead of the public option? the answer is a resounding it depends. And I like that.

I think it would be cool to see the different approaches states take. If all goes exceptionally well, over time, some consensus should be found.

I also found it interesting that the letter, on page 10, notes:

The proposed co-ops had very little effect on the estimates of total enrollment in the exchanges or federal costs because, as they are described in the legislation, they seemed unlikely to establish a significant market presence in many areas of the country or to noticeably affect federal subsidy payments

If I'm reading that right, the CBO doesn't think the co-ops will have that big an impact. That's OK, and I'm still glad to see them in the mix. What, if after all, they turn out to be a better option than the so called Public Option? By having them as an option, we should get to see this.

Sure, by leaving the choice up to states, the debate on these issues continues. And that's also a good thing. The whole notion that we will get this 100% perfect, the first time around, is a down right silly goal.