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As Congress’ summer vacation (and the confrontational town hall meetings that consumed it) winds down, one question, more than ever, dominates the health care debate. Is a government-run insurance program, otherwise known as the public option, essential for health care reform?

any activists and bloggers, who believe that abandonment of the public option is a betrayal to the progressive cause, would have you believe the answer is yes. So would Speaker of the House Nancy Pelosi (D-Calif.) and the Congressional Progressive Caucus, the members of which have promised to vote against any bill that does not include a public option. But this aggressive sentiment is misleading.

It’s important, first, to compare rhetoric to reality. Mendacious Republican attacks denounce reform as a government takeover of health care, and promises from Democrats call reform comprehensive. Neither characterization is true.

In truth, the consensus emerging in Congress suffers from a split personality. In one sense, Congress and the administration’s approach is transformative. All of the bills under consideration would provide near-universal health coverage, a step long overdue in this country. Yet the bill does not make a concerted attempt to redesign the flawed and costly structure of American health care.

As originally conceived, the public option would pursue such far-reaching reform by offering a government alternative to all Americans. But what Congress calls a “public option” is much more modest.

If adopted, only a limited group would have access to the public plan though regional insurance exchanges, in which regulated private plans would also compete for customers. This group would primarily include the most vulnerable in today’s market: the uninsured, the unemployed and low-income workers. The vast majority of insured Americans, who receive coverage through employer-provided plans, would see little in terms of cost reduction.

In this context, the argument that a public plan is an absolute necessity for comprehensive health care reform is irrelevant. The right question to be asking is whether or not the weaker, exchange-based public option is indispensable for the relatively modest reform that is actually on the table.

It certainly wouldn’t be a bad idea.

A lack of regional competition for private insurers is one major cause of spiraling health insurance premiums. Setting up the exchanges, which would force private plans to compete, would result in some cost reduction. A public plan, however, would boost this cost-reducing power. Like Medicare, a public plan could exploit a relatively large market share and the clout of the federal government to negotiate low prices. Plus, a public plan would not be subject to the high overhead costs that private insurers face due to marketing.

Another reason for a public option is that new regulations of insurers will not be completely enforceable. A public plan would force compliance by threatening to lure mistreated customers away from any shoddy private plans in the exchanges.

So even a weak public option is worth fighting for. It would deliver better care at lower costs for those buying coverage in the new exchanges. But its absence is not significant enough to compel progressives to scuttle the whole package. Not even close.

A bill without a public option would curtail the worst abuses of the insurance industry, even assuming imperfect enforcement. Millions of uninsured Americans would receive coverage. And millions more who have lost their jobs or fear losing their jobs would find comfort knowing they would not also lose their health coverage. This is a tremendous victory.

It could be said that threats to vote against a bill without a public option are mere bluffs to keep the option in the bill. But conservative Democrats and the stray moderate Republican will not take such posturing seriously when they know that their brethren on the left should find much to love in a bill without a public option.

Progressives should instead use their considerable sway to accomplish two other objectives. The first is impeding the adoption of the inane co-op proposal favored by some senators. If co-ops passed, the government would waste billions to jumpstart nonprofit insurance groups that would be too small to achieve real cost reduction.

The second is getting forcefully behind a far better compromise: a trigger for a public plan. Under this proposal, key benchmarks – a specified level of cost reduction and compliance with new regulations – would be established for the exchanges. If private plans failed to deliver, a public plan would automatically come into play.

If progressives are using the public-option issue to lash out at the president for his failure to adopt a more sweeping approach to reform, their criticism should reflect that. But recent outbursts suggesting that the proposed public option is the totality of reform are hyperbolic and irresponsible. The public option is indeed worth fighting for, but it is not worth failure.

Sam Harbourt is a senior in the School of Foreign Service. The Pragmatic Progressive appears every other Monday at www.thehoya.com.

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