Comments on: I’m for a public option. Just not this public option.

By: Karoli

Karoli — Sat, 06 Mar 2010 23:52:51 +0000

Lars, here's where process matters. They can't just pull any old set of provisions out of the air and stick them in a reconciliation bill. There's a tight line to walk between policy and budget items here. Had the two bills gone to a conference committee, I guarantee you they would not have emerged with a shiny new robust version of a public option. If one were included at all, it would have been one very similar to the version in the House bill, as I outlined. Why?

1) The Senate isn't the only issue. The House matters, too. They squeaked a public option through with Stupak language attached the first time. That won't happen a second time. They don't have the votes.
2) Assuming you have 50 and Biden in the Senate, how do you get a public option that matters even a little bit in the House without getting Stupak's coathanger provision shoved down our throats? As it is, getting to 216 without one is going to be a challenge. I can't see it happening at all without swallowing the nasty poison pill that is Stupak-Pitts. If by some miracle it did happen, I cannot imagine it would be worth crowing about.
3) What is the justification for creating a brand-new agency when one already exists? This is probably the most powerful argument the Republicans (and Lieberman) had. The Medicare buy-in would have been a far better option. I suppose we all should have hated it so Lieberman could feel like he was screwing us, but who knew he was so bitter?

You ask: Why not allow an up or down vote on the public option? My answer: Because defeating it will kill it. Not defeating it (or voting on it) with this package gives us all a reason to come back and fight another day.

By: Lars Olsson

Lars Olsson — Sat, 06 Mar 2010 22:33:44 +0000

I'm not sure why you assume that any public option offered through reconciliation would have to be "this public option," as you put it. Unless I'm missing something, since the reconciliation bill will be a new bill, designed specifically to fix deficiencies and lack of true reform in the Senate bill, what's to stop ANY public option plan from being presented (within the limits of the Byrd rule, obviously)?

I'm not against an expansion of Medicare. But I think it is pure folly to not push as hard on all fronts as we can while the momentum is here and we're this close. Incrementalists love to point out to the tired nostrum that "we can fix it later." While obviously true, this leaves aside the equally true observations that "we" can also just as easily fail to fix it later due to lack of political will/spine, or we can (some of us, with the tacit support of others) significantly worsen/screw it up later. While it's certainly true that any legislation passed today COULD be fixed later, it's specious to base assumptions on the fact that it WILL (and yes, I know the history of Medicare...). I mean, can anyone name a time when Democrats have failed to muster up the political nerve to attempt something that might very well have been possible? Anyone? Bueller? Actually, perhaps a better cinematic comparison would not be Ben Stein in Ferris Bueller's Day Off, but rather Hugo Weaving in The Fellowship of the Ring - when he says to Ian McKellen's Gandalf "I was there the day the strength of men failed!" Any one of us who've been watching politics for any length of time could easily say that in regard to the Democratic party. We've got an opportunity to put these guys on the record right now, in a way that will likely not be possible again for who knows how long. In fact, if what we pass and retroactively label "reform" turns out to be watered-down and hobbled enough to be credibly portrayed once the data start flowing in as anything BUT reform (or as reform in name only), then we may NEVER again have such a chance...or at least not until the situation is so horrifically dire that people are FORCED to revisit this issue because the cost of doing nothing is far higher than the cost of re-examining some of our most-cherished beliefs about the health care system in America, including the belief that we just can't GET truly progressive reform....because the insurers and their lap dogs in congress wouldn't allow it.

These guys sometimes play a game of "rotating bad guy": selecting one person to do the dirty work of killing a popular piece of legislation or part of a bill, because certain very powerful special interests are against it. Right now, PCCC's Senate whip count is showing numerous senators simply as "unknown" with regard to the public option. OK, let's put them on the record. Hold the damn vote. Make senators publicly stand up for whoever's interest they truly represent. Why - this late in the game - is Jon Tester allowed to simply go as "unknown" on such an issue. Blanche Lincoln is also listed as "unknown," but we can be sure that she probably would oppose such a move. Only I wouldn't bet on it. As her own re-election prospects dim (assuming she holds true to her constituent-disappointing MO), she might very well be "gettable" in the sense of throwing a last minute, desperate hail mary. Conrad, McCaskill, Mark Pryor, Jim Webb -- we are allowing all of these people to simply, during one of the most momentous and contentious times in legislative history in decades - simply lie in the weeds without taking a position. The President just the other day reiterated his support for a public option (though of course he took the cheeseball excuse of saying "but it doesn't have the votes in the Senate"). Harry Reid says he supports the idea.

Fine. Let's put it to a vote. What is STOPPING us from doing so, in fact? The President thinks the Senate doesn't have the votes? So? The President is no longer a member of the Senate. How 'bout letting them take care of figuring that out, Barack, instead of putting your thumb on the scale? Harry Reid supports it? Why not allow a vote on it, then? I'm less worried about what version of the public option we bring to a vote (though of course that's crucial, too) than I am in actually agreeing to put people on the record one way or the other about it.

By: Aviva

Aviva — Sat, 06 Mar 2010 10:01:44 +0000

You're most welcome. Or, as they say in San Miguel, “de nada.” ☼

By: Aviva

Aviva — Sat, 06 Mar 2010 10:00:54 +0000

Like your comments, @bill_free. Agree with them, too!

By: Karoli

Karoli — Thu, 04 Mar 2010 22:41:58 +0000

aviva,

thanks so much for putting these together! I was thinking last night I'd like to have this series of discussion points attached to the post. Greatly appreciated.

By: Karoli

Karoli — Thu, 04 Mar 2010 22:39:53 +0000

bll

I've been saying for awhile that Medicare has to have some serious infrastructure changes and oversight before we could move to a single payer model. It's not an especially popular view, but what I see tells me my gut is probably right.

I think keeping the pressure on for a public option in this round is an okay strategy to keep some bargaining chips in play to prevent further erosion of a bill which is already quite centrist. What concerns me is how it's being communicated as a larger issue. Progressives have placed a great deal of weight on this one piece of the picture, and will feel slapped when it's not included. I doubt very much that it will be, and in fact, hope it won't be in order to protect the right to try for a much broader Medicare expansion in the future.

By: bill_free

bill_free — Thu, 04 Mar 2010 19:55:50 +0000

Agreed. When the "Medicare for all" meme briefly caught fire last summer I was, briefly, hopeful that it might have legislative promise. From a policy standpoint, it makes far more sense to expand Medicare than it does to create a second public entity, especially one that is actuarially suspect and seems designed to fail.

Regardless of the merits, trying to force a public option into an already complex legislative calculus seems counterproductive. Publicly endorsing a "strong" public option in no way promises a vote for whatever winds up in the reconciliation package. There's a good chance it could send the whole deal down in flames.

At this stage, expressing support for single payer as a matter of principle is fine. But not at the expense of the biggest advancement in health care policy in a half century.

By: Aviva

Aviva — Thu, 04 Mar 2010 14:43:09 +0000

My feedback in those earlier tweets, but gathered together:

Aviva O .@Karoli: Still reading, but a dubiously-defined public option isn’t worth crashing the passage of an #HCR bill this spring!
Aviva O .@Karoli: Another reason I don't like the dubious, ill-defined, patchworky #PO; it creates an expensive, duplicative, complex bureaucracy.
Aviva O .@Karoli (2) Yes. Don’t like potential for #PO to interfere w/ states going #singlepayer; or interference w/ eventual national #singlepayer
Aviva O .@Karoli (3) Yes. #PO places Medicare at greater risk for privatization, with #PO foisted on us as poor substitute. Unacceptable.
Aviva O .@Karoli (4) Fundamentally agree w/ shift to Medicare-for-All over time. Requiring permanent opt-in while Medicare is mutable seems unfair.
Aviva O .@Karoli: Mandating opt-in to Medicare as permanent commitment demands reciprocal commitment from Medicare to be a stable product/service.
Aviva O .@Karoli: Similarly, mandating that U.S. citizens all purchase private insurance while there's no real competition demands huge amt of trust
Aviva O .@Karoli: Just as House faces a temporal chasm in accepting Senate bill while waiting to see if Senate honors reconciliation fix agreements…
Aviva O .@Karoli: …mandating purchase of private insurance + making a choice for Medicare a permanent one is a lot to ask during transition + flux
Aviva O .@Karoli: I'm not sure which of these two (mandates, Medicare one-time opt-in), is riskier when longer-term outcomes are unpredictable.
Aviva O .@Karoli: With those caveats (fair, bilateral agreements between subscriber + provider vis a vis mandates/permanent opt-ins to Medicare),
Aviva O .@Karoli And with the exhaustion I feel, reading this after being up all night, I say with trepidation that you've outlined a good scenario
Aviva O .@catawu: You make a good point; Medicare shouldn't be "raidable" for its surpluses. And Social Security isn't a bank for whatever goes!
Aviva O .@Karoli: I think there DO have to be (a) benchmarks before lock-in; or (b) exits if certain changes do/don't occur in Medicare. Complex.
Aviva O .@Karoli I understand your reasoning on why a choice for Medicare MUST be a commited choice; what's "chosen" must be a known entity, though.
Aviva O .@Karoli: The fact that we'll be mandated to buy private insurance that's NOT a known entity really bugs me. I don't have a workaround, tho.
Aviva O .@Karoli: Good addition; it's crucial to know what one's "buying in to" or "opting in to." Or, what one's mandated to purchase!
Aviva O .@Karoli: I think you've got some meaty, substantive, + viable proposals; the scenario is basically sound; much risk remains buried in it.

By: Aviva

Aviva — Thu, 04 Mar 2010 14:43:09 +0000

By: Aviva

Aviva — Thu, 04 Mar 2010 14:43:09 +0000