The success (or failure) of national health care reform does not balance on the fate of a “public option” for health insurance. If the votes for its existence do not exist in Congress — by all accounts, they don’t — hanging onto its inclusion could sink other, important changes.

Popular support for a public option is based, in part, on populist resentment of insurance company profits and premiums. While there are good reasons to be angry at insurance companies, it must be considered that achieving universal coverage is more possible with them, than without them.

The cases in point are the two tacks taken by Maine and Massachusetts in addressing the uninsured within their borders. Maine developed its own public option program, Dirigo Health. Massachusetts went for regulation, compelling residents to purchase insurance (with subsidies available for lower incomes).

As the national debate on health care has unfolded, it has not been Maine’s decision that has been lauded, even though a federal public option has been touted as the most crucial aspect of reform. Instead, Massachusetts’ success in covering its uninsured has earned the laurels.

Why? The easiest of answers: results. Massachusetts has delivered coverage, leaving it to boast the nation’s lowest rate of uninsured, by far: 4.1 percent, according to figures released in September by the Census Bureau. Maine, by comparison, had an uninsured rate of 10.9 percent, which is little different than pre-Dirigo Health.

It boils down to one question: What is the goal of reform? Is it to break the insurance companies, or provide coverage to all Americans? The answer should be the latter, yet the insistence that a public option is the make-or-break facet of any policy seems to insinuate the former.

If Massachusetts can provide near-universal coverage without engaging in the possibly costly experiment of a public option, there’s little reason to lament the votes of the Senate Finance Committee, which rejected the inclusion of a public option in reform legislation twice last week.

At best, the public option would have reduced insurance premiums by shaking up the insurance market; in fact, we’ve said the option has merit as a market-based solution. Yet, at worst, the public option could have become a political time bomb inside health reform, just waiting to blow progress to smithereens.

It should be rejected. Massachusetts’ example proves that universal coverage is possible without it, as long as policymakers exert their influence. Sen. Olympia Snowe, speaking of influence, has voiced concerns about fining people for lacking health insurance, a point on which she should be flexible.

Some penalty will be needed if the goal is universal coverage. Massachusetts imposes a fee of less than $100 per month, for example, depending on calculations of income and affordability.

No public option is no problem. In the long-term, putting the option aside could become viewed as what makes health reform, as a whole, possible.

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