How changing our health care got so un-scary.

Consider Tuesday's bipartisan ceremony in which President Obama signed the Edward M. Kennedy Serve America Act. Thirteen years ago, Republicans in Congress tried to kill Bill Clinton's AmeriCorps program. This year, Republicans and Democrats joined together to pass the largest expansion of service opportunities in decades. Tomorrow isn't always defined by yesterday.

The "public plan" idea is a good one and the issue is important: if the government makes it possible for everyone to buy health coverage, one option among many should be a government-run health insurance plan akin to Medicare.


and only if

Private insurers hate the idea because they think the public plan would undercut them in the marketplace. This argument is, in some ways, self-refuting. If the private insurers are right that the government would actually provide health coverage more cheaply than the private companies, why shouldn't that option be available? Wouldn't it save taxpayers money in the long run?

As a negotiating tactic, they should hold firm to get as close to a decent public plan as they can. Obama himself said at last month's health care summit that the public option "gives consumers more choices" and helps "keep the private sector honest, because there's some competition out there."

And in a little-noted session last week sponsored by the Kaiser Family Foundation, Nancy-Ann DeParle, the White House health reform director, suggested that payment rates to both doctors and hospitals could be set at similar rates in both public and private plans to make sure that private insurers weren't driven out of business.

The biggest difference between now and the last time around is the emphasis on creative compromise in place of creative obstruction. Public plan advocates should stay at the table to keep things moving.

Someday, that will happen with universal health coverage. If a bill passes this year, enhancements in the program down the road will not be seen as controversial but as inevitable.

E.J. Dionne, Jr. is the author of the recently published Souled Out: Reclaiming Faith and Politics After the Religious Right. He is a Washington Post columnist, a senior fellow at the Brookings Institution, and a professor at Georgetown University.

By E.J. Dionne, Jr.