Monday, November 23, 2009

Public Plan and the 2008 Campaign

Liberals are up in arms, and with some reason, because Joe Lieberman is insisting that the Democrats running for president last year, including Barack Obama, did not include a public option in their heath care reform proposals at the time.

Lieberman is wrong.

But he's not the only one rewriting history, and his version is, as much as I hate to say it, a lot closer to reality than the idea that Democratic fraidy-cats abandoned a single-payer system after the election. That's a version of history that some liberals are pushing; it's the version of history that, for example, Robert Reich seems to be pushing in this post. Here's Reich:
First there was Medicare for all 300 million of us. But that was a non-starter because private insurers and Big Pharma wouldn't hear of it, and Republicans and "centrists" thought it was too much like what they have up in Canada -- which, by the way, cost Canadians only 10 percent of their GDP and covers every Canadian. (Our current system of private for-profit insurers costs 16 percent of GDP and leaves out 45 million people.)
OK, let's stop right there. Medicare for all might be a great idea, but it wasn't defeated by private insurers, Big Pharma, Republicans, and centrists. It was defeated by the Democratic voters of the Iowa caucuses, who supported three candidates who opposed that plan.

OK, let him continue:
So the compromise was to give all Americans the option of buying into a "Medicare-like plan" that competed with private insurers.
Yes...and no. Yes, Obama (and Clinton, and Edwards) supported a public a relatively minor component of their health care reform plans. The idea that the public plan was in any way, shape or form central to the Democrat's health care reform ideas in the 2008 campaign is just not true.


The Democratic Party platform devotes about three and a half pages to health care reform. It mentions a public plan. Once. At the end of a sentence about increasing choice, after the part about increasing choices among private plans. No one could honestly read the Democrat's platform and walk away thinking that a public plan is a key component of health care reform.

There's one paragraph about health care in Obama's acceptance speech from the Democratic convention. It doesn't mention a public plan.

Remember the debate between Obama and Clinton right after Edwards dropped out? It was in Los Angeles, with Wolf Blitzer moderating? They spent plenty of time on health care. They focused on their differences (the individual mandate was the big thing), but they each got a chance to roll out their talking points. Obama did talk about a public plan, right at the beginning, but he hardly talked about it as the centerpiece of his plan. Clinton, for her part, didn't mention a public plan; she stressed letting Americans into the "congressional plan," but that's more about the exchanges than it is about new government-run insurance. Again, while both candidates certainly supported a public plan, it was peripheral at best to the discussion.

One more example. The second Obama/McCain debate was over domestic programs, and contained a lengthy discussion of health care. By now, Obama had dropped talking about a government option, and had adopted Clinton's "congressional plan" rhetoric. In fact, McCain didn't even attack Obama on the public option; he attacked him over employer and individual mandates.

So, just to be clear, there's no question that Joe Lieberman is wrong: Obama did in fact include a public plan as part of his reform proposal during the campaign.

But liberals are also wrong to think that Democrats campaigned mainly on a public option, and that compromising it down to a smaller size or even (should it happen) moving ahead with out it is some sort of inexplicable betrayal. I want to get back to Reich. He says:
Our private, for-profit health insurance system, designed to fatten the profits of private health insurers and Big Pharma, is about to be turned over to ... our private, for-profit health care system. Except that now private health insurers and Big Pharma will be getting some 30 million additional customers, paid for by the rest of us.

Upbeat policy wonks and political spinners who tend to see only portions of cups that are full will point out some good things: no pre-existing conditions, insurance exchanges, 30 million more Americans covered. But in reality, the cup is 90 percent empty. Most of us will remain stuck with little or no choice -- dependent on private insurers who care only about the bottom line, who deny our claims, who charge us more and more for co-payments and deductibles, who bury us in forms, who don't take our calls.
To which I think the only possible reply is: of course that's what's going to happen! That's what the Democrats -- not just Obama, but all the presidential candidates -- campaigned on.

The truth of this is that Harry Truman, Lyndon Johnson, and Ted Kennedy campaign for universal care, not public insurance. It's outrageous that a supposed liberal could consider coverage for 30 million Americans a minor point, less than ten percent of the goal. Certainly, liberals should be fighting for the best bill they can get, and if in their judgment a public option is critical to that, they should fight for it. But the idea that the public option trumps anything else isn't about fighting for the things that Ted Kennedy fought for; it's about seeing the world through ideological blinders.

One more thing. Reich concludes by insisting that the Senate vote on a single-payer system, and on a robust public option. Senators will be glad to do so; I don't know what small fraction of the Senate would support the former, and it's clear that the latter would draw somewhere south of fifty votes. Everyone on both sides would be happy to cast those votes. In fact, I think every Senator has declared positions on those policies, although I don't know that they'll bother to vote because the outcome is clear. Now, a weak public option probably could clear fifty if that were enough, and the Reid public option (weak with opt out) seems to have close to fifty-five votes, so liberals have a reasonable complaint there about the rules of the Senate and majorities. (I'm not saying I agree, but it's clearly reasonable).

But complaining because Harry Reid can't get single-payer?

Take it up with Democrats in Iowa.


  1. Nice.

    It's been odd to watch my fellow liberals re-write history when it comes to the public option & the 2008 campaign. I followed Obama's campaign pretty closely and never heard the phrase "public option" so I was surprised when this became the most crucial aspect of health care reform to liberals last summer. In general, I think a lot of liberals regret not really pushing for single payer in 08 and have latched onto the public option as the next best thing but really the single payer or even public option as centerpiece of health reform needed to be hashed out in the campaign like you said.

  2. I think that's right, although I also think that a single-payer plan would have been a tough sell in the general election. Both Clinton and Obama placed a lot of emphasis on everyone being able to keep their current insurance, which suggests that "keep your current insurance" must poll really well.

    I do think it would have been interesting if Edwards had run on single-payer platform.


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