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That assumes, of course, that a Congress that rejected a public option on the first go-round would allow the trigger mechanism to be activated. I have pretty strong doubts that it would.
In general, I don't find Nichols' vision of a public option very cheering. It either wouldn't keep costs down or would keep them down very little—and would do so by manhandling those most in need of health care to roughly the same extent that private plans do. But perhaps it would provide something to build on. I don't honestly believe the government would allow the manhandling—or, if it did, I don't believe it would allow that treatment for very long. Nor do I think it would allow the public option to sustain the "death spiral" described by Starr any more than it allowed the theoretically independent FannieMae to go broke.
Still, I could be wrong. I'd never have guessed that, six years after Medicare introduced a drug benefit, it would still be forbidden to negotiate prices with pharmaceutical companies. Health reform might fix that, but it probably won't.
E-mail Timothy Noah at firstname.lastname@example.org.
Correction, Nov. 18, 2009: An earlier version of this column misspelled Bertko's last name. ( Return to the corrected sentence.)