It's reminding me of that commercial - I can't remember what it's for - with the two little girls sitting at the table, and the nice man in the suit asking one of them if she would like a pony (really, how fitting is this?).  When she says "yes," he hands her a little plastic toy pony.  He asks the other little girl, and she, too, says yes, whereupon he "clucks: and out walks a real, live pony.  The kid who got the toy looks ticked, and she says, "you didn't say I could have a real pony," and the man's rejoinder is, "you didn't ask for one."

If all you do is ask for a public option via reconciliation, and don't define it, don't be surprised if the "pony" you get is just a little plastic toy.

The public option won't be an issue unless it's made to be one.

Force people to vote for or against it.

But Hacker's confusion (and the confusion of other PO leaders) over whether the PO would be more feasible than a single-payer was MINOR compared to the confusion that set in when congressional Democrats adopted a microscopic version of Hacker's original PO. When the Democrats released their draft legislation in June 2009, it was clear they had stripped out four of the five criteria for the public company that Hacker had specified in his original papers.

The only criterion the Democrats kept was the one requiring insurance companies to offer the same coverage as the PO. The other four criteria -

• the one calling for prepopulation of the PO,
  
• the one requiring that only the PO get subsidies,
  
• the one requiring that the PO be available to all non-elderly Americans, and
  
• the one authorizing Medicare's reimbursement rates
  
• all four of those criteria were gone. Now it was crystal clear to anyone who understood what Hacker had originally proposed that the PO the Democrats had adopted was so small it wouldn't affect the insurance industry. The Congressional Budget Office said the Senate version of the PO would insure no one; it said the House version would insure 10 million, and then later scaled that back to 6 million.

Now that the PO had been shriveled down from 129 million people to zero to 6 million, PO advocates faced not only the same old political feasibility problem (the insurance industry and the Republicans continued to scream about the tiny PO as if it were a big PO or a single-payer), but they also faced a huge logistical problem. A PO that represented no one on the day it opened for business wouldn't be able to crack most insurance markets in the US, and might not even be able to survive.
This is where Hacker's habit of always comparing the PO to Medicare became extremely misleading. When Medicare commenced operations on July 1, 1966, it represented nearly all seniors. With the exception of a few hospitals in the south that temporarily resisted integrating their facilities, all clinics and hospitals in America immediately began accepting Medicare enrollees even though there was no law requiring them to do so. The reason all clinics and hospitals did that is that Medicare represented an enormous constituency on day one and providers didn't want to walk away from so many patients and so much money.

The tiny PO the Democrats incorporated into their bills was no Medicare. It would represent no one on the day it opened for business. It would have to do what NO insurance company has done in the last three or four decades, which is to create a new, successful insurance company in every state in the US. In fact, I'm pretty sure no insurance company has expanded into even ONE new market in the last three decades by building a new insurance company from scratch. For the last three decades, insurance companies that wanted to expand their empires have done so by BUYING their way into new markets. That is, they bought an existing insurance company.

But Hacker and other PO advocates blithely ignored this issue. They ignored it because they continued to talk about the Democrats' PO as if it were the same huge PO Hacker had originally proposed. I might add that the CBO totally ignored this issue as well. The CBO never examined the issue of whether the PO would be able to crack even one US market, much less all of them. I think the CBO was being extremely generous to the House version of the PO when they said it would insure 6 million people.

Nevertheless, as inexplicably rosy as it was, the CBO's reports on the PO sealed its fate. The poor PO was already hated by the right wing and the insurance industry. It was being promoted by people who cared more about an insurance industry bailout than the PO. And now the CBO was revealing the truth about the Democrats' version of the PO - that it was laughably small and for that reason was going to save little or no money.
When Democrats throughout Congress, especially those in swing districts, asked themselves why they should vote for something as controversial as a PO when the darn thing wouldn't save any money, PO advocates had no answers.

But labor leaders have grown wary that the Obama administration and Congress are scaling back their ambitions for healthcare reform despite the president's insistence that he has not. Losing union support for the healthcare effort would be a damaging blow. Organized labor has been one of the staunchest proponents of finishing the job on healthcare reform.

"It appears that the administration and Congress will be taking a much more modest approach to healthcare reform. The cost and value of such reform would not justify using an excise tax," Larry Cohen, president of the Communications Workers of America, told The New York Times. The communications union has been among the most vocal labor organization in its opposition to the tax.

You never use this sentence construction if you actually want to get anywhere with the second part of the sentence.

Our system of government has worked for a long time.  While I am aware that recent use of the filibuster has increased dramatically, once you open Pandora's box you can never close it.  Reconciliation will become the way to do things forever.  I know there are rules about when it can be used, but I'm sure the powers that be will figure ways around those.  It will change the way the senate works forever and I'm not sure that is a good thing. If the rules are going to be changed, that should be debated on its own merits.

I also think there will be tremendous blowback on the Dems if we  pass health care through the use of the reconciliation process which was never intended to pass major legislation.  The Repubs will paint it as a abuse of power and they will have a point.

Seniors and the disabled already pay monthly fees for Medicare, as well as medicine costs. Congress should simply open up Medicare to citizens (not to all residents, as the healthcare welfare bill HR676 would) at a fee that is less than what companies and individuals currently pay to insurance companies. It wouldn't be socialized medicine, because anyone can still pay rip-off insurance companies instead of buying Medicare, and it's not available to non-citizens, so it won't become the next new welfare program to attract non-citizens to come here illegally. Hence, no angry backlash from Independents and conservatives, many of whom would be happy to save 30% on their healthcare costs.