Public option is a low priority for much of the public

As the Senate begins debate this week on health care legislation, the question of whether to keep the bill's provision for a government-run health insurance plan, known as the public option, will probably be one of the most contentious.

The Democrats still have not nailed down the 60 votes they need to pass the provision. Three conservative Democrats and one independent are threatening to scuttle the entire legislation if the public option, as now written, stays in.

Meanwhile the House, which narrowly passed its own bill on Nov. 7 with a public option, faces a similar standoff. Both liberal and conservative Democrats insist they will defect next time unless the final bill either keeps or drops the public option.

For some lawmakers, the public option is crucial to overhauling the health care system, while for others it portends a government takeover that would spell the demise of the private insurance industry.

But what about the public? Do people really care that much about the public option?

Surveys show that a majority of the public supports it. But those supporters value other objectives of a health care overhaul, like lowering costs, even more. A deeper look at the polls suggests that the importance of the public option may have been magnified as a political issue beyond its immediate effect on the health insurance system, although both sides say its power, for good or ill, would become evident over time.

To begin with, a public option would attract only a few million people, the Congressional Budget Office predicts. Those people would probably be sicker than the general population. For that reason, and because their numbers would be relatively small, their premiums would be higher than for private insurance.

The public remains deeply divided about the overall health care bills, suggesting that for many, their support for the public option is not strong enough to outweigh their doubts about other parts of the bills.

Even those who identify themselves as Democrats are not that wedded to a public option. In a November survey by the Kaiser Family Foundation, released last week, they ranked it seventh in importance, far behind "affordability" and "accessibility" of medical care.

Two weeks ago, the Pew Research Center for the People and the Press asked respondents the main reason they either supported or opposed the health care bills. Among supporters, only 2 percent cited the public option. Among opponents, only 3 percent did so.