Run on the public option

From the diaries, jerome.

In a way, the fact that a public option wasn't included in the health care reform law is a great opportunity for progressives. It would have been preferable to include the public option in the original law, without a doubt. And it would would certainly be nice to pass a public option during a second round of budget reconciliation in this session of Congress - but I'm not holding my breath. Nevertheless, defeat in this session may be a blessing in disguise, since progressive Democrats now have a clear and popular issue they can, and should, rally around for the mid-term elections.

The polling forecast for Democrats in the mid-term elections has been looking rather miserable for a while now, both in the House and in the Senate, and while there appears to be a health care bounce, it's too early to say whether that will be long-lived, or whether it will be enough to revive Democratic election prospects.

But whatever happens to Congressional Democrats, fighting for the public option in the mid-term elections is a good short-term strategy for progressives. What's more, it may yield significant long-term benefits as well. More in the extended entry.

Short term - an easy sell, a tight spot, and maybe some better policy

The public option has always been one of the most popular provisions of the health care reform bill. Notwithstanding the Senate vote-counting, opinion polls regularly showed the public option with plenty of popular support, even in the midst of last summer's heated conservative protests. Much was made of a poll last fall which showed plenty of trouble for Blanche Lincoln if she voted against the public option, because Arkansas voters wanted it. Of course, the popularity of the public option makes perfect sense, given the historic, third-rail popularity of Medicare - the public option is just a more universally-accessible version of Medicare. Alan Grayson's let-anyone-buy-Medicare bill would just take that idea to its logical conclusion; it's also a handy bill for progressive Democrats to rally around this year.

It should be easy to sell the public something we know they already want, but running on the public option is even easier than that, from a campaign mechanics point of view. Removed from the broader goal of health care reform, the public option policy is easy to explain, and the benefits to voters are immediately apparent. The message is clear: if enough progressive Democrats are elected, then everyone will have the choice to buy into the public option (or Medicare). The ability to buy into Medicare should be a tantalizing promise for anyone sick of health care insurance bureaucracy, worried about unemployment, or considering leaving their current job to strike out on their own; in other words, it should be enormously popular.

What's more, running on the public option puts both Republicans and corporatist Democrats in an unfavorable position. Republicans are universally opposed to the public option, and requiring them to oppose it during election season should dampen the built-in advantage they will have for being the opposition party during a recession. Corporatist Democrats, who are opposed to the public option but afraid to say so directly, are stuck with a variety of poor messaging choices. They can ignore the public option alternative altogether and try to defend the health care law as it stands; they can try a host of lame excuses; or they can lie outright about their support for a public option.

Taking the offense on the public option also allows progressive Democrats to avoid a defensive posture, which is, oddly enough, what seems to be evolving as the message after this week's victory. Democrats appear poised to defend the health care law, with messages that run the gambit from publishing lists of benefits the law confers right away (and by contrast drawing attention to the benefits the law does not confer immediately, most notably a public option), to noting the law's roots in conservative think tanks (and thereby undermining the message that this law is a Democratic victory, and that Democrats deserve re-election by extension.) Democrats will certainly be forced into a defensive posture on the economy, and while there are some signs of improvement, we are still a far cry from recovery; economic misery is likely to be a hot topic in the elections, regardless of how the economic indicators pan out. (Indeed, running on the public option can be paired well with an approach that takes the offensive on jobs.)

To be sure, running on the public option is not without its risks. There is a very real danger that voters are experiencing "health care fatigue" after a long, drawn-out battle, which, we've just been told, is over and done. More than that, the public option issue is close enough to the third rail of Medicare that candidates will have to be careful not to appear to be endangering Medicare; questions about Medicare solvency and the cost and logistics of expanding the problem will have to be answered. Finally, candidates standing up for the public option may well face a donor blackout, or other forms of blowback, from Obama and the DNC, and potentially from other Democratic interest groups.

The best outcome of the 2010 elections would be a Democratic Congress with a majority progressive faction, and with progressives in key positions of leadership. Obviously, the idea of running on the public option is designed to deliver that outcome. But even if it fails numerically, the public option campaign could still succeed by creating ripple effects in 2011-2012.

To begin with, the public option campaign may create enough pressure to actually pass the legislation in the next session of Congress. We came very, very close to enacting a public option this year, with a solid bloc of supporters in the House and majority support in the Senate. We lost the fight for a whole variety of reasons, but the point is that one or two primary defeats, or even one or two solid but unsuccessful primary challenges, may well be enough to frighten wavering votes in the next session.

Furthermore, the public option campaign could be an effective shot across the bow of the Obama administration and Democratic leadership. It would send a message that economically populist federal policy can be successful at the ballot box. That, in turn, could create a more explicitly jobs-oriented recovery, and it might even be enough to help the White House break loose of its disturbing taste for policy-by-corporate-agreement. With any luck, we could have a more equitable and broadly shared recovery by 2012 - just in time to rescue the Obama administration from itself.

Long term - forging a progressive identity and preparing for mandates

Even supposing that the public option campaign doesn't get much traction in 2010, progressive Democrats should still continue to press for the policy into the future.

The most immediate reason for pursuing the public option is that it can help progressive Democrats defend themselves against what is sure to be considerable ire once the individual mandates take effect. Government mandates to purchase a private product are never a good idea, and that is doubly true when the private product is largely unpopular, bureaucratic, and inefficient. The public option is the proper counter-balance to individual mandates, since it allows individuals to obey the law by participating in a program over which they have control and ownership. If progressives are unsuccessful in enacting a public option by the time the individual mandates kick in - and let's hope that doesn't happen - then at least they can point to a long history of advocating for a more rational and equitable system.

Furthermore, advocating for a public option might be our best bet to addressing the solvency problems for Medicare. Expanding Medicare's insurance pool to include a larger, younger, and healthier base could be just the right step needed to prevent the system from going bankrupt. As a flagship progressive program, shoring up Medicare should be a top long-term priority for progressives.

Finally, and perhaps most significantly from a movement-centric point of view, the public option allows progressives to define an identity distinct from that of Barack Obama. The fact that Obama is widely (though incorrectly, in my view) identified as a progressive is a major problem for the progressive movement. If you don't like him, the problem is obvious: Obama is co-opting our identity and mucking it up with corporatist policies.

But even if you do like Obama, this fusion is a problem, because it means that progressivism is largely defined in terms defined by the Obama administration. The widespread description of the health care bill passing as a progressive victory should be a warning sign for everyone: the passage was a major victory for the Obama administration and Democratic leadership, and there was progressive policy in the bill, but it certainly was not a progressive victory, because it didn't contain the signature item on the progressive health care agenda (i.e., the public option), and because it dealt a severe setback to reproductive health and choice for women. The only way to say that this fight was a progressive victory is if you believe that any Obama victory is a progressive victory or, to put it another way, that the progressive movement is just a subset of the Obama administration. Even if you are happy about having the progressive movement defined as an arm of the Obama administration, which is the logical conclusion of this kind of assertion, you have to worry about what's next for the movement. What happens after the 2016 election, when Obama will have to leave office? Or what happens if some major scandal causes popular support for the administration to collapse? We'll be stuck with an identity crisis just as profound as the one conservatives faced as the Bush administration was falling apart.

The public option, and economic populism more broadly, is one solution to solving this problem. By fighting vociferously for a public option, even in defiance of the likely blowback from the White House and DNC, we will be establishing an agenda item that is ours and ours alone. To use Rick Perlstein's metaphor, we will be laying down a "marker" - promising the public that if progressives get enough power, then the public is guaranteed to be "paid" with a public option.

It's possible that we will not be able to enact a universally-accessible public option for ten or twenty years - and maybe longer. The opposition to it from the health insurance industry is fierce, and the health care law will make that industry even more powerful and more profitable. But we need to build the pressure for this policy, and to gather as much electoral force behind it as possible, right away. There is sufficient support in Congress right now that a slightly more Democratic caucus in the next session might push us over the line; and even if we fail in the next session, it is long past time to build a distinct, robust, economically populist identity for the progressive movement.

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not buying it

Congressional Democrats conned us for most of last year on the public option. House Progressives promised to fight for it and all caved but a handful. Senate Dems assured us we had 55 votes for it but not 60--then, once the reconciliation route became available, suddenly we didn't even have 50 votes for the pubilc option.

Furthermore, Democrats ran for three or four election cycles on re-importation of prescription drugs, letting Medicare negotiate for lower prices, etc. We couldn't keep those promises either. The last thing I want is another phony Democratic crusade for the public option, when we all know how it will end (with Congress selling out as usual).

by desmoinesdem 2010-03-27 09:17PM | 1 recs
RE: not buying it

Not necessarily a time to give up though. On prescription drugs for example we have 30 dems on record in favor and 22 repubs. It would have passed in fact if the GOP filibuster hadn't put the threshold at 60 rather than 51. Giving medicare a robust mandate to negotiate for prescription drugs like the VA would be good too.

by vecky 2010-03-27 11:04PM | 0 recs
RE: not buying it

I know, it's really, really frustrating. But what can you do?  Giving up should not be an option for the progressive movement (setting aside the progressive representatives, for a minute).  I think this is one of those things where we have to demonstrate that there's sufficient electoral power behind universally-available Medicare to cause, at the minimum, a good deal of worry for incumbents.

by Shai Sachs 2010-03-28 09:16AM | 0 recs
Soon, everyone except the hospital monopolies will want

to reduce the age limit for enorolling in Medicare. Without lifetime limits and with guarenteed issue, insurers will be desperate to shed their older customers before they start getting expensive. For the insurers it is a win/win to get 60 year old over to Medicare: they avoid the downside risk of big payouts, and still make good money on Medicare supplimental and Medicare advantage programs.

by Mark Wallace 2010-03-27 11:23PM | 0 recs
RE: Soon, everyone except the hospital monopolies will want

That's an interesting point, and the implied legislative strategy (ie. getting to universal Medicare by continually dropping the buy-in age, as a negotiating strategy) is not a bad one.  Of course, it'd be nice to build the necessary electoral power to make the system universal in one shot - both as a matter of basic justice and also because it would help make the system more stable.

by Shai Sachs 2010-03-28 09:14AM | 0 recs


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