Be careful  what you wish for! Maggie Mahar,  who writes the Century Foundation's Healthbeat blog,  had a piece in the Washington Post's Sunday Outlook section calling for a public plan option -- but telling progressives who had yearned for a fully single payer system to visualize the downside.  Just imagine, she wrote, if a movement conservative like Sarah Palin ends up making the rules.  That could make the current controversy about abortion in the health insurance exchange seem tame. What about coverage of contraceptives? Or the ability to decline life support? Think the government wouldn't intrude on such sensitive private decisions? Ever heard of Terri Schiavo?

Of course, we do usually have checks and balances in our system. The party that controls the White House doesn't always control Congress, and it's even rarer for one party to control the White House, the House and a filibuster-proof Senate. And as anyone who has watched the long and winding road of President Obama's health reform agenda, even a filibuster-proof Senate has a mind (and politics) of its own.  Still, Maggie makes a point:

I'm very happy to have a public plan as an option. But since I don't know who will be in the White House in the years to come, I'm glad that government-run health care won't be the only game in town. If you're not happy about the Stupak [abortion] amendment, imagine what other limits a conservative government could impose on our health care.

With such an administration in power, social conservatives might move to exert pressure on health-care decisions beyond abortion. For example, could women be told that their government insurance won't cover birth control? In 2001, President George W. Bush proposed eliminating the requirement that all Federal Employees Health Benefits plans include coverage for contraception. At the time, Susan Orr, who would later become Bush's deputy assistant secretary of health and human services for population affairs, applauded the president's suggestion, saying: "We're quite pleased because fertility is not a disease. It's not a medical necessity that you have [contraception.]"

... Or take end-of-life counseling, and hospice and palliative care. Do you remember how Jeb Bush, then governor of Florida, responded when Terri Schiavo's husband fought for her right to die? It's quite possible that under a single-payer system, conservatives would push to overturn laws that allow physicians to withhold food and water if this is what a dying patient has requested. Recently, Rep. Charles Boustany Jr. (R-La.) raised this issue, objecting to the fact that the House's health-care reform legislation does not prohibit the use of federal funds to pay for end-of-life care that involves denying nutrition and hydration. Boustany, a surgeon, doesn't want patients to have that choice. So much for death with dignity.

She also points out that right and left have different views of "affordability" and how much "skin in the game" consumers should have. So while she still  strongly advocates for a public plan option, for now, she's happy to have it be just that. An option.

BTW, we liked Maggie's post from earlier this month, "Health Care Reform - Looking at the Glass Half-Full."  It's a lengthy post, but we particularly liked her assessment of consumer protections in House and Senate bills. The bills do a lot to help low income people, and if the subsidies aren't quite as generous to the middle class as some had hoped, they are still getting Real Insurance -- protection against a bottomless pit of medical bills, and the threat of bankruptcy or losing their home in a medical crisis. 

I think it is important to recognize  that we cannot expect this first piece of health reform legislation to be anything but wildly imperfect.  In fact, I'm impressed by the progress Washington has made in just ten months. I've been watching the struggle for health care reform since the early 1970s, and compared to what has happened over the past 39 years, this is mind -boggling.

We've been emphasizing this ourselves. (See posts here and here for instance.) There are provisions we aren't crazy about in these bills. There are problems we will still have to solve. But there is also a lot to embrace.