Two days ago I encouraged people not to get too caught up whether or not the public option is in the final reform bill — that the keep piece is the individual mandate. I think I want to amend that.
A couple of things have happened since I wrote that post. The first is that Republicans have publicly demonstrated that opposition to the public option is really a proxy for being in favor of not doing anything. The discussion of dropping the public option led to an interesting thing — Republicans attacking co-ops, which are the watered down compromise replacement for the public option that nobody puts much stock in. To be clear, I don’t care what Republican politicians think about health care reform. Conservatives have value to add to the discussion, but Republicans don’t care about the outcome of the bill. They care about the outcome of the political process. So we can’t assume they are making any of their arguments in good faith.
I do care what the more conservative Democrats in the Senate think. In order for reform to pass, we either need enough Republican support to make them feel safe or we need to peel those conservative Democrats away from the Republicans that they usually cling to for political cover.
It is much more apparent now that there is no version of health care reform that more than a few Republicans in the Senate will support. So it’s time to move on, working under the assumption that the Democrats in the Senate can see what’s going on as well as we can. And if we’re cutting the Republicans loose and putting the screws to the conservative Democrats to get on board, we should definitely keep the public option.
The second thing I’ve learned is that some people are strongly against being forced to purchase insurance from a private insurance company. One of the Republicans working on health care reform in the Senate Finance Committee says the bill needs to be broken up and debated in pieces, but most pieces of the bill are interdependent. You can’t demand that insurance companies offer plans at the same rate to people with different health histories without expanding the risk pool, for example. You can’t mandate that everyone purchase health insurance without subsidizing the poor. And maybe you can’t mandate that everyone purchase health insurance unless you give them a public option to choose.
Speaking personally, I still wouldn’t consider a reform bill that is enacted without the public option a defeat, but I think it would be a huge mistake to give up on the public option prematurely. There’s only one time to give up on it — when the final bill is in conference and the Congressional Democrats find that they do not have enough votes to pass it unless that gets dropped.