Yes and no. I think there are three factors in the survival of the public option. It polls well; it scores well; and liberal activists and pols decided to elevate public option over any of the other seemingly important liberal goals that they could have sought to achieve.
It's the choice by liberals that still baffles me (well, actually, I don't know why public option polls well either, but that's not about actions by political actors, so I'm not as interested). I understand the case for the public option, and I understand why it is attractive to liberals. But nothing I've read about health care reform that suggests to me that the public option is, in any logical sense, the make-or-break issue for either "real" reform or "liberal" reform. Certainly not in the severely constrained versions that are on the table in any of the current bills. What is clear, however, is that liberals did make that choice.
Did it move politicians? I think that's a fair conclusion, based on what we know now, but I wouldn't oversell that conclusion. Imagine a world in which liberals had chosen a multipronged lobbying effort (including things such as subsidy levels, strong individual and employer mandates, and opening the exchanges to all) instead of focusing narrowly on public option. What happens to the public option in that case? It certainly survives in the House, but the version in the House bill would most likely have been weaker -- although not necessarily, because the stronger public option may score better than the weaker variation. Odds are that the Senate would have wound up with either Snowe's trigger, or perhaps some beefed-up version of Conrad's co-ops. And then...well, there's really no way of knowing, but it's not entirely clear that the final bill coming out of conference would have been all that different. Of course, we don't know what the conference version will actually be, but it's not as if a less single-minded focus on the public option would have meant that House liberals would have been quick to dump it. Especially since it appears to poll well and score well.
At the same time, liberal activists have put almost no muscle behind the other important pieces in the bill -- for example, over at Open Left, Chris Bowers and Mike Lux barely acknowledge the existence of any other issues in their post-Reid posts. Bowers's piece is the interesting one. He says that liberals were able to exert influence because of the nature of the issue, since there was:
A clear demand (a non-trigger public option) in return for the votes of Congressional Progressives. (The strategy probably won't work for something as murky as new financial regulations.)But of course liberals could make a single clear demand for something as murky as new financial regulations, and health care is certainly very murky. It's just that liberals have chosen to treat it as if it wasn't murky, and as if there was one obvious demand to make that would satisfy them.
Just as we can't know the fate of the public option had liberals diluted their support, we also can't know whether attention by liberal activists to these other issues would have made a difference. If Ron Wyden was less of a lone wolf on opening the exchanges, would the Finance Committee have been forced to accommodate his concerns? Would subsidy levels be higher? Would there be more money available for subsidies if liberals were more insistent on taxing the wealthy, as the House tried to do (but will probably have to give up)? What if liberals had demanded, not specific provisions, but a coverage target?
Again, I don't know the answers, but I do think it's clear that the liberal strategy involved trade-offs, and I don't think it's at all obvious at this point that they chose the correct path.
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Liberals care about the public option because they really want single payer. The public option could, over time, morph into single payer. Eligibility has to be widened and it has to demonstrate better value for money than insurance plans, but single payer offers a credible path to an eventual single payer system. This may seem unlikely to centrists, it lives as a real promise in the minds of ideological liberals and a threat in the minds of ideological conservatives.
ReplyDeletePrivate insurance with mandates can give universal coverage, etc. Such systems work well enough in several countries, offering comparable (though a tad worse) value for money. So why the fuss?
Sure, liberals think single payer is better policy, but that isn't what animates them. They desperately want to reverse the fantastically successful Reagan meme that government is aleays and everywhere less efficient than markets, and they think health care is an area where that truism can be falsified in a way that is obvious to the broad middle. Such a victory can rearrange the landscape. It can be imagined as a beachhead in a long-term drive to take back ground given up over the past three decades. It is an extension of the New Deal, proving its continuing relevance seventy years after the Great Depression.
A private but universal health care system is a big victory in terms of positive impact on people's lives, but doesn't carry the same transformative promise in its echoes and after-effects.
I suspect that you are puzzled by the passion the public option elicits because you are not very ideolgical. True partisans look at the big victories won by Roosevelt and later by Reagan, and they see this as a main chance.