WASHINGTON – Congress has promised healthcare reform legislation by July 31. Expect fireworks when they get down to the nitty-gritty, as the public plan option – proposed by some Democrats – is sure to be one of the choices.

White House Office of Health Reform director Nancy-Ann DeParle said she is surprised how many Republicans don't know what Democrats mean by a public plan option.

The president is proposing a mechanism to lower costs and keep the private sector honest; a government-sponsored health plan operated by private health plans, according to DeParle.

Uwe Reinhardt, an economics professor at Princeton University, said at a recent Congressional hearing," If you treat healthcare like a social good, then it is unavoidable that the government must administer it."

Reinhardt said he can’t understand why some Americans decry government-run healthcare when that is exactly what the nation has chosen for its veterans.

Cost will be a big sticking point in any public plan. Ranking Senate Finance Committee member Charles Grassley (R-Iowa) is skeptical.

"When we can’t afford the public health plan we have already, does it make sense to add more? " he asked.
Sen. Max Baucus (D-Mont.), chairman of the Finance Committee, is working first on common ground issues that both sides can agree upon. For now, the public plan is "on the side of the table," he said recently.

Congressional Democrats and the Obama administration have said they want bipartisan support for health reform because reform won’t be sustainable over the long haul without it. Yet House Democrats have alluded that they won't be squeamish if it comes down to using their majority, and a few loopholes, to push legislation through.

A public plan has a wide array of supporters. Leaders of Doctors for America, with 11,000 members, say they are open to it. So is the Center for American Progress Action Fund.

But nobody wants it more than small employers. At a recent White House summit, they told DeParle the rising cost of healthcare is breaking them. But they continue to sacrifice the welfare of their businesses to provide coverage – something about which they feel strongly.

"Small businesses are the engine of our economy, but the cards are stacked against us now," said the owner of a Seattle coffee shop.

Health and Human Services Secretary Kathleen Sebelius has said public and private plans can coexist. Thirty states already offer both, without detriment to private insurance.

"I'm committed to designing a level playing field." she told a House panel. "The current situation is unaffordable, unsustainable and unacceptable."

Most Americans and lawmakers agree that a change in U.S. healthcare is absolutely essential. But what kind of change will it be? Look for the fireworks.