Friday, March 22, 2013

Catch of the Day

Ezra Klein asks one of my favorite questions today: what ever happened to the public option?

Regular readers will know that I've been dead wrong on this one, at least so far. I thought it would be an extremely popular position for Democratic politicians, especially those running in competitive primaries. In fact, I thought it would be virtually required for such candidates. But it wasn't, really, in 2010, and it was only rarely mentioned in 2012. That was even true in Senate primaries, for example, in New Mexico and Hawaii, in which one would have expected the candidates to try to score points with Democratic activists.

And yet? Virtually nothing.

So I don't understand it, either.

Great catch!


  1. One possibility: maybe progressives never cared about it anywhere near as much as was commonly perceived. My position has always been that I wanted the bill to include a public option, but it wasn't close to being a deal-breaker for me. Like most liberals my ideal is single-payer, but as long as we're going to have this heavily compromised, insurance company-friendly law, I never saw that huge a difference between the ACA with a public option and without it, even though I preferred the former. I've encountered more than a few liberals who are ignorant about what the public option is and who assume it is equivalent to single-payer (someone I was talking to on Ta-Nehisi Coates' blog actually referred to the "single-payer public option"). But previously I assumed I was in the minority among liberals in thinking the absence of the public option was not that big a deal; now I'm beginning to wonder if their emphasis on it was more symbolic than substantive. They saw it as something achievable that was at least somewhere in the vicinity of their ultimate goal of single-payer, and therefore they fought hard for it. But after it failed, not only did they become disillusioned (what hope is there for passing it in the future when they couldn't get it through the most liberal Congress in a generation?), they grew more conscious of its limitations as a progressive cause.

    1. So, how about what a public option is? Would it have allowed the uninsured to buy in to Medicare? Or, would it mean that instead of buying insurance from the private sector, a government run program would be the public option. As to what happened to it, Jonathan, don't you remember that bold majority leader telling everyone "we don't have the votes?" I don't understand why Reid didn't force a vote and put members of both parties on record. If the option was as popular as polling suggested, perhaps the pressure to vote for it would have materialized. I know, what if....

  2. With the ACA debate settled, at least for now, I think letting the talk, particularly the public option talk, might be a good thing, a 'cooling off' period. But I see lots of pressure in the system that may force some sort of public option down the road, and not too far down the road, either.

    I don't know the latest count, but many states are not going to set up insurance exchanges, they're going to let the feds do it.

    If there are not enough options within a state exchange to provoke competition, you'll see the political pressure for a public option develop. If taxpayers are going to have to pick up the tab for overpriced crappy product then offering a non-profit government-run alternative may well be cheaper; particularly if it has the bargaining power that equals that of insurance companies.

    Another step toward a public option may come from those unwilling to purchase insurance and the 'tax' they have to pay; it will, I suspect, morph into a medicaid-like buy-in; a back door to a public option, for those folk will still need health care at some point or another.

    Finally, many states have opted not to set up the exchanges; to let the Federal Government run them. If there are not enough private options in those exchanges, it will put political pressure on for a public option. And in sparsely populated states, I think that's exactly what we're going to see; few options with high price tags or worthless coverage.

  3. Ahem, on the West Coast there is still an active single-payer grassroots movement, disproportionately including health care professionals.

    They aren't taken seriously by "serious actors" in the Democratic party, probably on the assumption that "We've done what we could do for health care and we're worried about defending it, not expanding it." And obviously they aren't taken seriously by political scientists either.

    1. The existence, or non-existence, or a single-payer tells us nothing about the popularity of the provision on the ACA exchanges of a public option, because they're apples and oranges.

      That's not really true, come to think of it. It can tell us that people can't tell them apart, or won't tell them apart, or gain political advantage from having them confused...

    2. Should reas "The existence, or non-existence, or a single-payer grassroots movement..."

  4. I agree with zic. At this point, it's probably best to concentrate on implementing what we have. Then we can see what quirks have to be ironed out.

    I seem to recall reading that by the time the public option was killed, it was already so compromised that it was going to cost more than private insurance anyhow. Does anyone else remember anything along those lines?

    But the public option does live on as part of the revised Ryan-brand Medicare, which is basically a private-insurance exchange including an option for traditional Medicare (and a cap on payments), no?

  5. I can't see what it is that a government-run insurance company that can't tax or legislate private competitors into submission is supposed to do to compete with private insurance companies. You liberals are weird.


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