Who says health reform is boring?

Tuesday's Senate Finance roundtable on expanding health care coverage got off to a raucous start as Chairman Max Baucus called the committee into recess while some passionate proponents of single-payer  took Harold Pollack's recent admonition not to "sit on their hands" a little too literally. Pollack's central message to fellow advocates of single payer, of course, was that "now is the time for practical politics." It was that spirit of political compromise that prevailed on the rest of the roundtable. A webcast of the discussion is available here, written testimony, including that of Len Nichols, the director of New America's director of Health Policy Program, here, and you can read our live play-by-play on Twitter.

Like last month's Senate Finance roundtable on delivery system reform, in many ways what was most impressive was amount of consensus on some very large components of health reform. Everyone seemed to agree that significant reforms were needed to make the health insurance market function for all Americans—especially those Americans who purchase coverage in the non-group or individual market.

We were particularly impressed to see the idea that all Americans should be required to have health insurance—provided it was affordable—taken as a pre-condition, rather than a point of contention for reform. When Senator Baucus asked if anyone disagreed with this assumption, no dissent was heard. AHIP's Karen Ignagni strongly emphasized that ensuring that all Americans had health coverage would allow the insurance companies to change many of their underwriting practices, including excluding people with pre-existing conditions. In the world of health care, we'd say that's progress.

Senators on both sides of the aisle agreed that more competition was needed and that some sort of insurance market exchange could help organize the market give and more choices to consumers. Specifically, Senator Olympia Snowe (R-ME) noted that consolidation had left many small businesses with few options, and Senator Blanche Lincoln (D-AR) emphasized that choices are often limited for many Americans living in rural areas.

The main point of contention was whether such a structure should give Americans the choice of a public health insurance option alongside other private plans. Proponents of a public health insurance option argued that a well-designed plan could help restore trust and provide a benchmark for consumers-provided it operated on a level playing field with private plans. Critics questioned whether the playing field could ever be level, but Robert Menendez, (D-NJ) implored stakeholders and his fellow senators not to reject the issue out hand without knowing the specifics.

Hoping to move past that impasse on a public plan, Senator Chuck Schumer laid out a blueprint for a consumer driven public plan. Dubbed a potential "middle ground" by the New York Times, Schumer's plan lays out several principals for a public health insurance option. They are:

• A public plan must adhere to the same rules as private plans
• The government shouldn't serve as both the player and the umpire-that is the officials who run the public plan must be different from those who regulate the insurance market
• A public plan must be self-sustaining. It cannot use Medicare as stick to compel providers to participate and providers to participate,
• It must pay more than Medicare rates
• Government subsidies (for low income people) should be should be uniform with no distinction between public and private plans.

Schumer's principals are sensible starting place to move the discussion forward. Tomorrow we'll follow up with some of the other highlights from the hearing.