How To Get The Public Option Through
Never underestimate the ability of professional politicians to thread a needle at the last minute to save themselves. If there is to be an individual mandate in the final health care reform bill, the public supports by large margins a non-profit or public option, to prevent families from being forced to buy health insurance from the same firms that have created the mess we have now. Yet senators of both parties on the Senate Finance Committee, bought and paid for by the industry, have produced a bill that requires cash-strapped American families to buy insurance from these same firms.
Sensing that Max Baucus, Kent Conrad, and the White House have allowed the process to produce a bill that will kill 2010 Democratic incumbents, Senate Democrats have begun discussing an alternative that would allow individual states to “opt out” of a “robust national public option”, if those states’ political leaders care more about their insurance industry benefactors than their own constituents.
F*cking brilliant. If the Blue Dogs and GOP trust the industry so much, this gives them a chance to show voters who they care about the most.
Sure, as expected many of my peers amongst the center-left blogosphere are against this because they want the whole loaf of a public option with no qualifiers to emerge from conference, rather than see Democrats negotiate amongst themselves. This is a good point – but irrelevant given that a full, unqualified public option will not get 60 votes in the Senate. This approach is sweet, because it forces Blue Dog and GOP senators, and their governors and legislatures back home to publicly commit their support to the industry over their constituents. If these DINOs and whored Republicans are so convinced that the Big Insurance lobby will take better care of their constituents than a national non-profit option, then make them lead a campaign back home to deny their constituents that choice.
I have no problem with this approach, and if it allows slugs like Ben Nelson, Joe Lieberman, Blanche Lincoln, Kent Conrad, Mary Landrieu, Mark Pryor, and Max Baucus to vote with several Republicans for a super majority in the Senate, great. It honors the states’ rights argument amongst the wingers, and will make it a little more difficult for even some GOP senators to still vote against it, even after Bob Dole said they should get aboard the train.
So sign me up. Politics is about the art of the possible, not purity. The White House blew this one a long time ago, so as long as the final product contains a nonprofit option to avoid an individual mandate that leaves your fate to the industry, I am aboard.
But Democrats still face a political problem, because most elements of any final reform bill, including a national, opt-out nonprofit option, won’t be operational until 2013, meaning voters will see no relief before the 2010 midterms. This is a recipe for disaster, given how easily the GOP does "scare-and-blame." The solution, from Howard Dean, is to expand Medicare in 2010 before the midterms to allow families in their 50’s to sign up and get coverage. And before Republicans whine about Democrats pushing something like that through for purely political reasons, stuff it guys: your party did the same thing in the dark of night with Medicare Part D, with phony cost calculations and by holding the vote open until all GOP votes were rounded up. So spare me any whining about Democrats now doing the same thing.
Update (Thursday, 10/8): Howard Dean is OK with the opt-out approach, if it gets a good bill out of the Senate with decent margins.