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Speculation is rife that the White House will cut loose the “public option”—i.e., the creation of a government health-insurance program to compete against private insurers. The signals aren’t new; I began worrying about this nearly six months ago. (See “Is Obama Soft on Health Insurance?”) The political mainstream seems to be greeting the latest hints from Health and Human Services Secretary Kathleen Sebeliusand others with its usual shrug that politics is the art of the possible; to make a deal, all sides may have to give something up. The trouble in this instance is that political pragmatism conflicts with programmatic pragmatism. Without a public option, there’s a very real danger that health reform simply won’t work. It might even make things worse.

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