"House Speaker Nancy Pelosi (D., Calif.) has said for weeks that the House bill would include a government-administered "public option" to compete with private insurers. Liberals want its payments to be tied to Medicare rates, which they argue would keep costs down. But centrist Democrats say Medicare's payments are too low, falling far short of the actual costs to hospitals and doctors of caring for patients. Democratic leaders have concluded they don't have the 218 votes needed to pass a bill tied to Medicare rates. "After a series of discussions over the last couple of days, we've come to realize it's very tough to get to that point," said Rep. George Miller (D., Calif.), chairman of the House Education and Labor Committee and an ally of Ms. Pelosi." - Steven Perez from Bookmarklet