Who doesn't have a health plan these days? Yesterday Joe Biden threw his three-ring binder into the ring at a press conference in Des Moines. What he laid out isn't really a plan as much as a plan for a plan: He calls it "four essential steps to lay the foundation for a comprehensive plan." Within the first 90 days of his administration, President Biden would bring together insurers, medical care providers, businesses, and labor with the challenge of developing a comprehensive plan in six months. (Good luck with that!)

In the meantime come the steps:

*Lowering the cost of health care through initiatives in prevention, chronic disease treatment, negotiated discounts for drugs through Medicare, and improved information technology. We've heard all that before, but Biden also promises to train and deploy 100,000 new nurses in the next five years.

*Covering all children with a generous expansion of the suddenly controversial S-CHIP program.

*Allowing uninsured adults to join Medicare or a federal plan like the one the government runs for its employees. Individuals would buy into the federal plan on a sliding scale. Small businesses would get a subsidy from the federal government -- the more low-wage workers on the payroll, the bigger the subsidy.

*Creating a federal reinsurance pool to spread catastrophic costs across the general population. According to the Biden campaign, "reducing the risk factor for health plans would translate into lower health insurance premiums." Importantly, small business pools would be able to use this pool provided "they comply with existing state laws and do not undercut state benefit mandates." (Republicans, and their allies at the NFIB, would allow small business association plans to cross state lines and flout state mandates.) Insurance companies could join the reinsurance pool provided they don't discriminate against customers.

(Biden's campaign hasn't organized its thoughts very well. I've aggregated these from two different sources, the press release for the Des Moines event, or the position paper on health care. The upshot is these bullet points don't quite coincide with either document. To those of you on the Biden staff: don't mention it.)

Biden is attempting to steer a moderate-seeming course. Unlike most of his Democratic rivals, Biden wouldn't require everyone to buy insurance. "I don't think you are going to need to mandate," he explained in Des Moines. "When affordable health care is available, people will buy it, they'll step into it," he said. But whatever the positioning, the effect is the same. So is the cost: Biden estimates his plan will run $80-$110 billion to implement, an upper boundary in line with estimates floated by John Edwards, Bill Richardson, and Hillary Clinton.