I admit that I watched the collective freakout over the President's "backing away" from the public option with some confusion. Though some are dismissing it as spin, it really did not seem as though they were saying anything new. Obama has repeatedly refused to draw a line in the sand over the public option, and Sebelius has said before that they will "consider" Kent Conrad's "co-op" proposal.
Whether it's a good idea or not to be noncommittal is another issue entirely. Personally, I think they should draw a line in the sand over the public option, or at least be stronger in their advocacy. But I can see the other side of the argument. And that may simply be that the administration does not want to kill the bill and is just trying to get something first,
out of the Finance committee and second,
out of the Senate.
It is very clear that it is going to be
very difficult for the Senate to pass a bill with a public option. According to DFA, only 37 senators are on record in support. The Republicans are unanimously opposed, and several Democrats have expressed hostility to it, including Blanche Lincoln, Kent Conrad, and Ben Nelson. Joe Lieberman has outright opposed it. Will it be Obama's fault if they defeat a public option in the Senate? In part - the bully pulpit is not insignificant. But let's also face the fact that senators are often, frankly, egotistical brats, who don't like to be pushed around and often like expressly to defy their leaders. (For some reason, Senate Democrats are notorious at this, far worse than their Republican cohorts, who are willing to vote for what their president pushes, lockstep; we can see both their successes - getting Bush's domestic and foreign policy agendas passed - and its failures - the fact they got... Bush's domestic and foreign policy agendas passed.) While people often cite Lyndon Johnson as an example of a president who knew how to bully the Senate, keep in mind he had over 70+ senators on his side, including liberal Republicans, and even he didn't try to attain universal coverage, settling for Medicare and Medicaid.
While some argue that the Senate should pass a bill through the reconciliation process, any bill sent through reconciliation would likely not include a public option, as the reconciliation process depends on the Senate parliamentarian's judgment and cannot usually be used to create new programs.
What does this mean? I think the odds are very high that the Senate will not pass a bill with a public option. However, it looks as though the House likely will include a public option. If the White House is truly committed to a public option, then conference committee is where pressure would - and should - be applied. If the bill coming out of conference includes a public option
AND passes the House, it becomes very difficult for the Senate to reject it. Bills coming out of conference cannot be amended. They are not subject to the normal rules of debate. While they can be filibustered, it is difficult to do so for the very reason that they cannot be amended, meaning that ultimately they have to come down to an up-or-down vote. And do Evan Bayh and Kent Conrad really want to go down in history for killing universal health care? Especially since no universal health care bill has
ever passed the House and all that would stand in the way of universal coverage would be a handful of conservative Democratic senators? (For more explanation on the conference process,
click here.)
What's the evidence that the administration is just trying to get to conference? There are a few indications. In a conference call with liberal bloggers about a month back, President Obama himself made clear that
conference is where the Administration plans to apply major pressure: The House bills and the Senate bills will not be identical. We know this. The politics are different, because the makeup of the Senate and the House are different and they operate on different rules. I am not interested in making the best the enemy of the good. There will be a conference committee where the House and Senate bills will be reconciled, and that will be a tough, lengthy and serious negotiation process.
I am less interested in making sure there's a litmus test of perfection on every committee than I am in going ahead and getting a bill off the floor of the House and off the floor of the Senate. Eighty percent of those two bills will overlap. There's going to be 20 percent that will be different in terms of how it will be funded, its approach to the public plan, its pay-or-play provisions. We shouldn't automatically assume that if any of the bills coming out of the committees don't meet our test, that there is a betrayal or failure. I think it's an honest process of trying to reconcile a lot of different interests in a very big bill.
Conference is where these differences will get ironed out. And that's where my bottom lines will remain: Does this bill cover all Americans? Does it drive down costs both in the public sector and the private sector over the long-term. Does it improve quality? Does it emphasize prevention and wellness? Does it have a serious package of insurance reforms so people aren't losing health care over a preexisting condition? Does it have a serious public option in place? Those are the kind of benchmarks I'll be using. But I'm not assuming either the House and Senate bills will match up perfectly with where I want to end up. But I am going to be insisting we get something done.
Moreover, Rahm Emanuel in the NYT seemed to acknowledge that they expect both that the Senate will not include a public option and that the House
cannot support a bill
without a public option:
“We have heard from both chambers that the House sees a public plan as essential for the final product, and the Senate believes it cannot pass it as constructed and a co-op is what they can do,” Mr. Emanuel said.
"We are cognizant of that fact.” (
Link.)
Now, does that mean people should simply role over and have faith in Obama to do push a public option in conference? I'm a defender of his, but I'd still say no. Ultimately, if we get to the point where a public option depends on the conference committee - and that looks very likely right now - it becomes a matter of which House of Congress is willing to blink first. And the calculations of the conference committee negotiators will hinge on which body is more likely to do so. That in turn will depend on the ground and the general mood. If progressives push hard for the public option, urging supporters in Congress to not support a final bill without it and making the White House know that they will not consider health care reform without a public option to be true reform, then the incentives shift such that conference will be more likely to support a public option.
If, however, public option advocates lay down their guard, liberals in the House may signal they'll support reform without a public option, and conservative Senate Democrats will think they can oppose it with impunity,
then it's unlikely the conference committee will include a public option. And let's face it: there's a reason liberals want this. Many health policy analysts are correct in saying that, as structured in the House and HELP committee bills, the public option really isn't going to be that important at the outset (meaning that Obama's statement that it is only a "small part" of the bill is quite true, as a literal matter). It will have to be self-supporting, and will be limited to the exchange, which will itself be limited to only the self-employed and those employed by small businesses. It won't have significant market power to drive down costs. But I think it's obvious why liberals still want it. It's far easier to expand programs than create new ones, and by establishing a "beachhead" public option (not just a carved out one for the poor and the elderly, ala Medicaid and Medicare), it can be expanded to the whole population, such that we could eventually get a de facto single-payer system or at least a mixed system with significant economies of scale associated with a single-payer system.
So by all means, fight for a public option. But be aware of the legislative process, and don't get discouraged if the Senate won't pass a bill with a public option in their first try. If the environment favors a public option, then a public option coming out of conference will be very difficult to stop. 
Printer-friendly format
Email this thread to a friend
Bookmark this thread
(1000+ posts)
Send PM |
Profile |
Ignore
