Don’t freak out about the public plan, yet or you can call it a turtle for all I care.

Yesterday, Secretary Sebelius said that the public option is not an “essential” part of health care reform but we do need some mechanism to provide “competition” for private insurers and a “choice” for Americans.

Many of us are concerned about what seems like a retreat by the Obama administration from something we’ve worked hard for, a public health insurance plan. But before we freak out, let me point out a couple of things:

1. The Obama Administration is putting out mixed messages. Yesterday, the deputy White House Press Secretary Jim Messina said,

“Nothing has changed. POTUS [President of the United States] has always said that what is essential is that health insurance reform must lower costs, ensure that there are affordable options for all Americans and increase choice and competition. He believes the public option is the best way to achieve those goals.”

2. Even if  Secretary Sebelius’ comment reflect President Obama’s position, we don’t know that it reflects a decision to give up on the public plan as opposed to

a. An attempt to diffuse the opposition to a “government takeover” by showing that regulation of private insurance is as important if not more important than the  public plan. Even underthe House bill, HR 3200, regulations on private insurance together with credits will be the mechanism by which most people secure affordable health insurance. The public plan was not meant to insure most people initially. Rather it’s goal is to provide competition that drives down costs and creates a backup for people in case insurers find a way around the new regulatory regime and leave some people uninsured.

b. A way to get a bill into a conference committee with a few Republican votes in the Senate. A public plan can be restored in conference and then pushed through the Senate via the reconciliation process after October 15.

c. An attempt to repackage the public plan in more attractive language. As I point out below  we have no idea what a co-op would look like. It could havemost of the features that we want a public plan to have.

d. All of the above.

3.  I’m not happy with Secretary Sebelius’ statement because I think it could undermine your enthusiams for working for health care reform. Don’t let it to do so! I expect progressives inside and outside of Congress to keep pushing for a public plan and not settle for legislation that does not actually provide choice and competition in health insurance. So let’s keep our eyes on the prize right now and build support in Congress for what we really want.

4. At some point, we might find that what is included in the bill is called a co-op not a public plan but that it still has everything we really care about. Secretary Sebelius said that she is still committed to choice and competition. We won’t have choice and competition unless

a. The alternative to private insurance  is national in scope.

b. The alternative to private insurance is able to use its bargaining power to negotiate reimbursements with doctors, hospitals, and pharmaceutical companies so as to lower costs.

c. The alterntative to private insurance has enough start up money from the government to get it up and running?

d. The alternative to private insurance is empowered to committed to adopting the same payment and delivery system improvements we are seeking in Medicare, to hold the growth of health care costs down? The governing body of the alternative to private insurance must be accountable to the public for doing this.

I could imagine something that might reasonably called a co-op that would do all this. So whether we call the competitor to private insurance  a coop or a public plan doesn’t matter so long as it provides real competition, a real choice, and a real mechanism to improve health care delivery in the country. Calling it a coop might actually make it more attractive to people. The key things we need to know are the details about how it is set up.

I see no sign that President Obama is backing down on all the things we want in an alternative to private insurance.

So, don’t freak out, yet.

Anything that cerates real competition and choice is going to look like what we call a public plan. If the administration wants to call it something else for political reasons–a health insurance program, a health insurance coop, or a health insurance turtle–it doesn’t matter so long as people have a real competitive alternative to private insurance.