Thursday, June 17, 2010

Update on the Future of the Public Option

Way back when, I argued that as long as the main health care bill passed, it didn't matter very much whether or not the public option was included because it was very likely to be added in the future.  So I was somewhat surprised to hear Ezra Klein make the opposite argument, in a post wondering about whether future health care savings are likely:
Of course, what's almost impossible to imagine is how we get from here to there. The wrenching, agonizing process that got us the Affordable Care Act was attached to a pretty modest bill that was careful not to strike at the core of our system. And anytime anyone suggested arming the bill with more dramatic reforms -- converting the employer-tax exclusion to a standard deduction, or adding a strong public option into the market -- the politicians recoiled, and quick. So if the inefficiency of the status quo provides a sort of abstract budgetary opportunity, the ferocity and number of its defenders provide an almost insurmountable political obstacle.
I'm sure that it's true that some future changes will be difficult, but I've always bought into the logic that I thought Klein believed in: once the framework is there, it's a lot easier to add to it.  Of course, "add to it" doesn't necessarily mean cost savings, but again I think it's a lot easier to tweak an existing tax than to create a new one, or to toughen cost controls than to implement them from scratch.  More to the point, here, I've argued that pols running in future Democratic primaries were very likely to support adding a public option.  The public option has always polled well, and liberals in particular believe it's very popular.  It scores well, and so those proposing it don't have the burden of finding cost offsets.  And I'm pretty sure it could be done through reconciliation. 

Enough about the logic: what about the results?  Are Democratic candidates this year running on a public option platform? 

I'd say the results so far are mixed.  I checked the web sites of the non-incumbent Democratic nominees for the Senate with the best chance of taking office, and then for those who did not say anything about public option in the issues section of their web sites, I did a (quick, noncomprehensive) search.  Here's the rundown:

Several clearly supported the public option; some emphasized it on their web sites.  Among these were Fisher (OH), Sestak (PA), Giannoulias (IL), and Hodes (NH), and Conway (KY).  Carnahan appears to have said some pro-public option things, although her web site is silent and the articles I looked at were somewhat ambiguous.   I found no evidence that Blumenthal (CT) supports a public option, but it seems likely to me that he would vote for it.   It does not appear that Ellsworth (IN), Melancon (LA), or Coons (DE) supports a public option.

I also checked the North Carolina Democrats, currently engaged in a runoff: Elaine Marshall featured support for a public option on her web site, while Cal Cunningham did not. Cunningham did give an interview in which he seemed to suggest that he was open to a public option in the future. 

I think on balance the evidence favors the idea that the public option is doing well.  Every candidate in a Democratic or swing state, and every candidate who is in or survived a tough primary, gives at least qualified support for a public option, except for two: Blumenthal in Connecticut and Coons in Delaware.  The two who oppose it -- certainly in Melancon's case and probably in Ellsworth's case -- were locked into their positions as Members of the House.  In the future, fewer Senate candidates will have that constraint. 

On the other hand, I can't say I saw a lot of enthusiasm behind the public option among these candidates.  Nor did I see a lot of emphasis on a "robust" public option, or other key words that would appeal to liberal activists.  I certainly didn't get the sense that adding a public option to the bill passed back in March would be a high priority for incoming Democrats in the next Senate.  Of course, if the Democrats lose either chamber then the public option will be dead for at least two years, anyway.

I didn't look at any ads, and for the most part I didn't look at primaries -- I was in this case just looking at the eventual nominees.  I'd be very interested to know whether the public option was used to establish liberal credentials or to differentiate one candidate from another in contested primaries this year (for both Senate and House). I also would be interested to know the extent to which netroots activists are using that issue as a key marker in choosing which candidates to support, and just generally how public option is holding up against other key liberal issues now that the big battle is over.  If the public option has lost momentum among activists, then my prediction of eventual enactment would almost certainly be wrong.   My sense, however, is that liberal activists are, as I expected, moving towards using support for the public option as a litmus test -- and if that's the case, the chance for it passing at some not-too-distant point looks pretty good.

1 comment:

  1. How much of the potential advances in health care is contingent on the results of this November? And those results of course could prove heavily dependent on the unemployment rate and the national economic outlook. I would agree that if we can largely avoid economic disaster, i.e., double-dip recession in the next quarter or so, we might be able to improve upon the HCR law. But what if electoral disaster does occur? Would this give SCOTUS an easier feeling about ruling the individual mandate unconstitutional. I know many people have scoffed at the notion the High Court would do that, but I can't help but see a 5-4 decision. Can we trust Justice Kennedy to preserve the law?


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