There's been a lot of noise about Sen. Maria Cantwell's (D-WA) position on health care—mostly from liberals and progressives who are flagging her as a problem for not leading the charge on the public option—defined as a government plan that competes with private insurers. Critics add that Cantwell may even be jeopardizing the public option by pushing a co-op option. (A co-op option, like Seattle's Group Health, is an alternative to HMO-style fee-for-service options. It features patients as owners, salaried doctors, and treats patients in a team care manner with bonuses to doctors for success. )

What's been missing from the coverage of Cantwell's position, I think, has been has been a conversation with Team Cantwell.

This afternoon, PubliCola spoke with Ciaran Clayton, Sen. Cantwell's spokeswoman, to get a better read on Sen. Cantwell's position.



Photo by Jefferson Jackson Steele

Our questions: Does Cantwell support the public option? And, if she does, does the co-op option—which her office told PubliCola last week must be on the table—count as a public option? That's what the PI implied in its coverage of Cantwell's health care forum at the University of Washington last week.

Clayton: "Senator Cantwell definitely supports the public option."

PubliCola: Does a co-op plan count as a public option?

Clayton: "It could, but it depends on how it's defined."

Clayton backed up here, pointing out that President Obama himself—the star advocate for the public option—hasn't provided a definition of the "public option" beyond saying it would consist of a government-run plan that competes with private insurers to keep those insurers honest.

Clayton says those are the same metrics Sen. Cantwell has, and explained that while the Group Health model does do some of the things Cantwell has in mind ("paying for performance rather than procedure") Group Health is still a private insurer. For the co-op option to meet Cantwell's standard for a public option, Clayton said, it would have to be "a government plan that competes with private insurers." Clayton cited large, government-run energy cooperatives like FDR's Tennessee Valley Authority that would bring the same kind of cooperative buying power to the table as private health insurers (as opposed to smaller outfits like Group Health.)

As for the criticism from lefty circles that Sen. Cantwell isn't taking the lead on the issue—she's on the Senate Finance Committee, which is drafting the bill—my sense is that Cantwell is working it behind the scenes. Clayton would only say that "as a member of the Finance Committee [Sen. Cantwell] is working on a plan to bring down costs and increase access."

Clayton added that Sen. Cantwell is "cognizant of the costs" of a big government plan, lamenting: "the deficit is what it is, the economy is what it is—she wants a bill that's paid for."