Wingnuts like Todd Akin may claim that all we have to do to solve our health care crisis is allow portability so that when workers change jobs, they can take their insurance with them. But with the latest NYT/CBS poll showing 72 percent of us in favor of a public option, his notions are out of touch to the point of being quaint. House Republicans have marginalized themselves, and House Democrats, more liberal than their Senate counterparts, will pass a strong public option. Last Friday:

Unified House Democrats unveiled a draft health care overhaul bill jointly endorsed by three powerful committee chairmen.

Henry Waxman, Charlie Rangel and George Miller, chairs of the Energy & Commerce, Ways & Means and Education & Labor Committees, announced the result of six months of negotiations. The sight of three united committee chairmen in the turf-conscious House is a historically rare one.

…[T]he House version includes a robust public plan that would operate nationally and compete with private insurers on a level playing field to keep them honest.

The public plan would be self-sustaining and not subsidized by the federal government, although an upfront infusion of capital would be needed. It would initially be tied to Medicare reimbursement rates, to capitalize on the existing infrastructure, but would evolve into a separate plan that paid higher rates. Participation by doctors would be voluntary.

Rangel described the public plan as “the best of Medicaid, best of Medicare, then kick it up a notch.” The chairmen estimated the plan would cover 95 percent of Americans.

That’s in the House. Then there’s the Senate.

The Senate is where you’ll find the Democratic turncoats that might have the power to stop this. At the other end of the Democratic spectrum from Conyers, Waxman, Rangel, and Miller–it’s painful even to call them Democrats–we’ve got senators Max Baucus, MT; Evan Bayh, IN; Ben Nelson, NE; Kent Conrad, N.D.; Blanche Lincoln, AR; and Mary Landrieu LA. They’re all busy trying not to appear to be dragging their feet on a public option–while their heels are dug in an inch.

Take Bayh, for example, who this winter formed a Blue Dog caucus. His wife, Susan, sits on corporate boards for a living–fourteen at last count–and one of them is Wellpoint, the biggest health insurer in the country. But he says her activities are no reason for concern: “‘The reality is, we don’t talk about stuff that she’s involved with.'” Oh, thank goodness. Imagine how reassured I was to hear it.

It does us little good to have 59 Democrats, 60 if Franken gets seated by this fall, if six of them might vote the wrong way on a public option. In fact, one of those six is even in charge of a committee considering a health care bill. There are two committees creating such bills.

The Senate Finance Committee, chaired by Max Baucus will almost surely produce the one with the weaker public option. Baucus wavers on that issue depending on whether he’s just visited his home state and been flayed by constituents for keeping single-payer advocates out of committee meetings or whether he’s been in D.C. listening to insiders again for a few days.

Well might he be tempted to waver. He’s taken in more money from the health insurance industry than any other legislator.

“In the past six years, nearly one-fourth of every dime raised by Baucus and his political-action committee has come from groups and individuals associated with drug companies, insurers, hospitals, medical-supply firms, health-service companies and other health professionals.”

Then there’s Chris Dodd, D-CT, who, in Kennedy’s absence, chairs the other relevant committee, the Health Committee. On the one hand, 23 percent of his contributions have come from the health care industry. On the other hand:

“I happen to be very strong for a public option,” Dodd said. “I think we need a public option in this bill. I’m going to do everything I can to see to it that a public option is included.”

What that option might actually look like isn’t known yet, but remember that there’s 72% support for a public option. Hell, you couldn’t get three-fourths of Americans to support Mom and apple pie. So it’s gonna happen. The question is whether it will be strong enough to be worth having.

Dodd’s HELP committee should be releasing details on its proposal this week. No doubt it will provide a stronger public option than whatever Baucus’ committee produces. Negotiations over a compromise bill will ensue. That bill might be very weak on the public option.

The problem is that if it isn’t weak  enough to suit Baucus, Nelson, Bayh, et.al., they could refuse to vote for it before it even has a chance to go to conference with the House to resolve differences in the two chambers’ versions. Democrats will have to either keep most of their own in line and maybe sway a couple of moderate Republicans in hopes of getting the 60 votes for cloture. Even Democrats, with all the herd instinct of cats, might turn lemming-like at that point. Blue Dogs will be risking their political futures if they vote nay on the health care bill.

But if Senate Democrats fail to get the sixty, they’ll be forced to use a little known–but quickly getting known–tactic called reconciliation that allows budget bills to bypass the cloture requirement. The simple definition of reconciliation is: fifty votes. No filibuster. The problem is that reconciliation isn’t that simple. Since this bill isn’t purely a budget bill, parts of it would be damaged in the reconciliation process:

“If Democrats decide to go down the reconciliation route, some of the bill will pass and some of it won’t,” said former Senate parliamentarian Robert Dove. “It will be a Swiss cheese bill, but it will be a bill.”

So the bottom line is that Democrats need to seat Al Franken, hold the Blue Dogs in line and maybe bring Olympia Snow and Susan Collins into the fold for that vote.

If they can do that, the bill goes to conference with the House, and since the House bill is going to be strong on the public option, the resulting bill will likely be stronger than what the Senate produced.

Which will bring on the final battle. The Senate, sometime this fall if the timetable holds, will vote on the conference bill. And all the same caveats about getting sixty votes or facing reconciliation will apply again. But this hurdle, for what may be a stronger bill, could be even tougher to clear. Then again, my other caveat will also obtain: that any Democrat who votes no will be risking his political future.

All that is still a ways off. Right now, we Missourians need to do our part to get our health care ducks in a row. We need to make sure that Claire McCaskill–Bond is a lost cause, of course–supports a strong public option. She has declared her support for the public option, so Clark urged us to go to her e-mail contact form, thank her for that support, and ask her these questions:

1–Do you support a public healthcare option as part of healt
hcare reform?

2–If so, do you support a public healthcare option that is available on day one?

3–Do you support a public healthcare option that is national, available everywhere, and accountable to Congress?

4–Do you support a public healthcare option that can bargain for rates from providers and big drug companies?

I don’t assume she’ll write back and say that she thinks what the House is considering is just dandy. But it couldn’t hurt to hope.