A public option, but what form?

It now seems nearly certain that Congress will not create a government health insurer to enter the marketplace to compel competition with private health insurers.

A few moderate Democratic senators voted no on that in the Finance Committee because, they said, the votes weren't there on the floor. But the votes weren't there on the floor because these few moderate Democratic senators weren't going to vote for the public option -- on the professed basis, you see, that the votes weren't there.

Alas, attention should now turn from such circular blather to four proposals for incremental versions of a public option. I'm thinking of them cumulatively, not exclusive of each other. That is to say I'm suggesting all of the below in an all-American stew.

U.S. Sen. Max Baucus, Democrat of Montana and Finance Committee chairman, wants to spend up to $6 billion to seed voluntary nonprofit health insurance cooperatives by which people would come together to insure themselves through ownership fees. It has worked for mutual life insurance and rural electrification, among other things.

U.S. Sen. Olympia Snowe of Maine, the only Republican seemingly open to the idea of working something out with Democrats, wants to trigger a federal public option only as a last resort. She suggests a trigger to apply only in circumstances by which the federal government's proposed new health insurance exchange failed to offer 95 percent of the residents of that area at least two "affordable" private options, with affordability based on a percentage of income.

We set up something like that on the Medicare prescription drug benefit, though circumstances haven't arisen for it to kick in.

Senate Majority Leader Harry Reid said the other day that Snowe's trigger is, while not as splendid as the public option itself, a "doggone good idea."

The threshold is perhaps too low. An option of two choices is barely an option. Maybe we could require three affordable private options to head off the triggering of a public option.

Meantime, U.S. Sen. Tom Carper, Democrat of Delaware, has the idea that, if we're not going to have a federally created public option, maybe we could fall back on the rights of states to set them up if they chose.

Carper has asked Reid, when the time comes to piece together a bill from conflicting Senate bills from two committees, to consider this: States could do the public option themselves. Or they could seed the co-ops themselves. Presumably they could get some federal help, as is the case with Medicaid.

Finally, U.S. Sen. Maria Cantwell, Democrat of Washington, has an idea whereby states would be authorized to negotiate with private health insurers inside their states to design hybrid public-private pools to cover the uninsured in those states.

So let's put all that together and see what we have.

The federal government would not encroach into the health insurance business beyond its current single-payer role for Medicare and veterans and its partnership with states in Medicaid.

That would be so unless it turned out there were areas underserved by competing private insurers, in which case, for these isolated areas, a federal government insurer would be created.

Meanwhile, states could act on their own, through their political and governing institutions, to set up public options or co-ops or hybrids inside their borders. Nothing would be mandated on any of our more conservative sovereign states.

In the meantime, the federal government would hold $6 billion to hand out to groups wanting to set up qualifying member-owned and nonprofit health insurance cooperatives.

Either all of that would fill our tragic health insurance gaps in a classically American stew-pot kind of way, or, through its dissipated ineptitude, it would make clear once and for all that we require a single federal government insurer.

John Brummett (jbrummett@ arkansasnews.com), is a columnist for the Arkansas News Bureau.