Reid’s work just starting

Because he believes Democrats must somehow straddle the Grand Canyon that is their caucus and pass something, or anything, on health care reform, Senate Majority Leader Harry Reid apparently has conceived of a plan.

First he intends to push the bill he's put together himself and which, rather impressively, the Congressional Budget Office says would actually reduce the deficit over 10 years.

You're wondering how that could possibly be, considering that the bill extends health insurance to an estimated 94 percent of the population and subsidizes a great many of those people.

First you raise taxes -- on high-income earners' Medicare payroll deductions and some of the high-end insurance plans offered by employers. Then you make cuts -- mostly in Medicare, through the government payments to the private Medicare Advantage program and in the growth curve of general administrative costs, but not, everyone promises, in benefits.

To pass this bill, Reid must secure 60 votes to end a Republican-led filibuster. Apparently he cannot achieve that so long as the bill contains something he was obliged to insert to assuage his liberal base. That would be a "public option" government insurer that would take effect nationwide and that states would have to take affirmative action to opt out of.

But Blanche Lincoln, Joe Lieberman, Mary Landrieu, Ben Nelson, Evan Bayh and Kent Conrad are disinclined or wholly averse. All are Democrats except Lieberman, an independent who caucuses with the Democrats. Sixty votes can't be achieved without all of them, since Republicans number 40.

So, for a fallback position, Reid has assigned Delaware's Tom Carper to come up with something else. That's because Carper, for weeks, has demonstrated a willingness to try to work something out and a propensity for incremental ideas.

Carper has been meeting with balking Democratic moderates. He says this is what he tends to hear from them consistently: They don't like a government insurer.

What Carper has been working on, then, is a hybrid of a hybrid. He has taken as a foundation the idea of Maine Republican Olympia Snowe to create a public option government insurer to be triggered to take effect only in limited areas where there were insufficient affordable private options available through a new health care exchange the government would create.

But since many of these Democrats eschew a government insurer, Carper has talked about adapting the trigger to make it not a public agency but a nonprofit cooperative, as Lincoln and Conrad and others have discussed.

In other words, the creation of a regional nonprofit health care cooperative would be triggered by certain defined circumstances in limited geographic areas. The federal government would appoint the board of the regional cooperative and provide the new regional entity seed capital to be repaid from actual cooperative receipts.

Reid has not wanted to talk about this because you don't negotiate well by announcing your fallback position, and liberals think this is so lame as to be nigh unto worthless. They'll swallow it only if they absolutely must, and they're not to that point yet.

They wanted single-payer government insurance. They've already been forced to retreat to a weak public option. Appointing board members to oversee backwoods health care nonprofit cooperatives -- well, that's one of the last things they had in mind when Barack Obama got elected promising universal health care.

The House has passed a public option already. A nonprofit cooperative trigger passed by the Senate would provide the countering boundary for negotiation. A public option trigger might be the logical middle ground in conference committee.

It's conceivable a public option trigger could do more good than a public option that states could opt out of. Several red states would opt out. But a trigger would apply in those states automatically if people were underserved by private options.

John Brummett is an award-winning columnist for the Arkansas News Bureau in Little Rock and author of "High Wire," a book about Bill Clinton's first year as president. His e-mail address is jbrummett@ arkansasnews.com.