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Monday, March 15, 2010

Healthcare: time for progressives to get a bit more Machiavellian

What does the administration mean when it says the public option doesn't have the votes in the Senate? It doesn't seem to make sense when 41 senators have signed the Bennett letter urging fellow senators to pass the public option in reconciliation, and more than nine others have at some time declared support for it (only 50 needed with Biden available to break a tie).

Here's what I think they really mean. Yes, we could possibly “ram through” the public option right now, but some senators do not feel they have enough “cover” yet against inevitable Republican attacks in their states. Many representatives feel the same way in their districts. Although it receives majority public support when explained, there is still too much misinformation and lack of understanding – yes, through the fault of a poor White House communications strategy. Republicans use it as “evidence” that the bill is a “government takeover,” and in the heat of a campaign it is hard to fight against such attacks with surface plausibility among those not yet inoculated against the relentless lying of the right wing.

After the main structure of the bill is passed, it will be much easier to get the public to focus on the public option, what it actually means and its significance for them. I have been making the argument on other blogs that not cramming it into this bill is a blessing in disguise. When accurately explained as a choice that people who must buy insurance through the exchanges would have, the support for such a public option in an August 2009 poll was 77% to 22%. Standing alone without the baggage of the main bill, a new public option bill, already popular, would only gain in public support, not only making it more likely to get done, but to be stronger than the watered-down public option version in the House bill today. Since it will be popular and will make the absurdity of the “government takeover” argument more obvious, it will also be easier for those at-risk senators to counter-attack against such right-wing talking points.

Here is one of the comments I entered on another blog elaborating on the benefit of holding off and making the public option the first great fix to the Healthcare Bill:

And progressives can help make it all happen by re-starting the public option debate as the first great fix to the healthcare bill, gaining more public support for the already-popular concept since it will now be unburdened by the other baggage in the main bill, forcing "centrist" Democrats to jump on board or be driven to K Street in the next couple of years, and forcing Republicans to take the side of insurance company profits and CEO salaries.

If he's smart, because it's a political fact that the public option will never go away until it's adopted, Obama will jump on board, too, regardless of what inappropriate promises were secretly made before. It will be dangerous for the next round for any Democrat to play around with the public option like so many did this time.

But not getting a watered-down public option now is a blessing. Progressives should not miss this opportunity. After a bit of good rabble-rousing, including a ringing declaration that the public option will never die or fade away and insurance companies and for-profit hospitals are going to have to deal with it someday soon, Bernie Sanders should withdraw the demand for a vote at this time on his public option bill, and use it over the next few months as a way for progressives to re-take their rightful position as the driving force of a strong Democratic Party -- and recapture the populist momentum for November.

Here's a somewhat more elaborate explanation below in one of my comments to another blog (slightly edited). I am 100% in the “Pass The Damn Bill” camp -- almost a charter member. That's because, mainly, I don't see how any liberal or progressive could in good conscience tell the parents who can't get a kid covered for a pre-existing condition they will have to wait another 5 or 10 years until we can (possibly) get a single-payer bill more to our liking, and if the kid dies we'll give them the omelet-eggs bromide; or to tell a family with an income of $50,000 – the national median – that tax credits reducing their premiums – for better insurance than cannot be denied or canceled and that will have no lifetime limit on claims paid – from, say, $1200 per month to $300 per month is a “worthless bill” or “worse than nothing.”

The public option in particular will be the subject of relentless progressive pressure and continuing growth in public support as it becomes better understood and is separated from the baggage of the main bill. When the question is phrased properly as a choice for people who cannot be covered by their employers and must buy insurance through the exchanges -- i.e., in many cases, people who have lost their jobs -- the public approval already approaches 80%. When they further understand the policy rationale, as a constraint on insurance company excess profits and CEO salaries, and when the remaining low-information independent voters start to realize how absurd the claim that it is a "government takeover," that public support will only solidify.

It will be politically very dangerous for Republicans to be on the side of the insurance companies against the interests of the people in the lowest costs possible. Democrats should be riding this issue all the way to November even if they temporarily refrain from including it in the main legislation. The Democratic mantra should be, from day one of passage, that everyone knows "the public option will never go away". It's an excellent policy idea and is very popular with the people -- and has tens of millions of passionate supporters comprising most of the Democratic Party (not just "the left"); accordingly, Democrats can score points with most Americans by delivering some "tough love" to the insurance industry, pharma, the AMA-type doctors and the for-profit hospitals, warning them they would be better off to stop fighting a war against a public option they will eventually lose and start trying to deal with that reality.

However, don't expect the heavily compromised Obama administration or Congressional leadership to lead the charge. That progressive passion is going to be the driving force that eventually, and probably long before the exchanges go into operation, makes it happen. As good Machiavellians in the service of high ideals, we should welcome this opportunity to grab center stage in the party for something most Americans will want.

Platitudes and generalities about whether or not a less-than-complete piece of legislation can be "fixed" later or be subject to incremental improvement are irrelevant. You have to look at the particular forces at work on particular changes. The stars are aligned for the public option to be the first big fix, whether Obama, Emanuel, Reid and Pelosi want it or not.

Democrats nationwide -- the real centrists who actually believe in historic American values like the rule of law and a strong middle class -- are sick of Republican-lite Democrats. They are desperate for candidates who are real Democrats. Any self-professed Democrat serving now who doesn't get on board for the next round on the public option will be in serious danger of not having the chance to do so again.

If Democrats keep the majority in Congress, we will get a public option. It may take the form of a so-called "Medicare Buy-In" for buyers in the exchanges, a version that "polls well," in DC insider parlance. My bet: we can still get it in 2010, but in any case we can get it before the exchanges go into operation. Not part of the main bill now? No harm, no foul. Pass The Damn Bill.


Blogger Dan said...

Thanks for the hopeful words. I think you are "Spot on," as Big Eddie would say. Yes, "Pass the bill." It's not what we wanted, but it's progress, and we don't have to say that this legislation is the last word. We'll live to fight another day.

12:30 PM  

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