22 February 2010

Why no Public Option?

It's been pointed out that the majority-vote reconciliation procedure would be a perfectly appropriate to re-introduce a public option (or even a medicare expansion) to the health care reform bill.  Reconciliation is supposed to be used for items which impact the budget and the deficit - essentially spending items and tax items.  Insurance exchanges do not, which, I suspect, is why the insurance exchanges remain state-run in the Obama proposal, rather than the preferable national insurance exchanges -- an attempt to modify that proposal in reconciliation would likely have been ruled out of order by the Senate parliamentarian and stripped from the bill. 

But the public option is another story.  It's pretty directly germane to spending and would likely be bullet-proof there.  There are certainly 50+ Senators on record in favor of a public option, and indeed 20 are already agitating for its inclusion in reconciliation.  It might also help bring some House liberals back on board.  And, has been pointed out, reform will be better electorally if the bill passed is a popular bill -- the public option is and always has been popular among the general public (not that most people really know what it means, but that's another story).  It's more popular than the Senate bill is.  So why isn't it in the Obama proposal to go through the reconciliation process and sweeten the deal?  In fact not only is it not in the plans, by all evidence, there's a surprising lack of enthusiasm from Democratic leadership, with the White House remaining silent and leaving it up to Reid, whereas Reid says that presidential support is necessary to reinstate the public option.

A few reasons I can think of:
  • Obama himself has never been a committed supporter of the public option.
  • The most recent "consensus" version of the public option was pretty weak and may be perceived as just not worth fighting for.
  • Democratic leadership has already resigned themselves to the loss on the option and are focused simply on getting a general bill passed.
  • Congressional Democrats are terrified of November and too timid to tack something "controversial" back on.
  • The Democratic coalition is, in reality, too fragile to survive the reinstatement of the public option.
I suspect that all are true to some degree, and I worry most about the last one.  The House whip count is something that insiders are very concerned about.  The Stupaks and the Blue Dogs are by no means certain in their support -- indeed, many did oppose the original House bill, and while their votes weren't ultimately needed, if they are needed, it's not clear that they'd be willing to take a risk by coming back on the compromise bill.  This seems wrongheaded to me -- the new bill is more conservative than the original House bill they opposed, and the electoral consequence of the bill's failure is probably more dire than the consequence of a conservative/swing district's representative voting in favor of a successful reform bill.  But it is what it is.

Ah, Democrats.  Is there nothing you can't screw up?

1 comment:

Alison said...

If I could propose one more reason...

It can be very tough to tease out the specific campaign contributions that come from each industry, but two charts on opensecrets.org bear contemplation.

In 2008, insurance companies (health, auto, life, home etc..) are connected to $46,732,566 in total campaign contributions. $20,795,998 of that went to Democrats and $2,328,520 to Obama.

Health services and HMOs (not including hospitals and nursing homes) are connected to $14,411,739 total contributions in 2008, $8,685,465 of that going to Democrats and $1,440,723 to Obama.

In 2008, the pharmaceutical and health products industry was connected to $29,602,895 in total contributions, $14,931,224 of that going to Democrats and $2,141,826 to President Obama.

The methodology used to come up with these numbers can be found at http://www.opensecrets.org/industries/methodology.php

I think it is worth considering that meaningful campaign finance reform might be a prerequisite to meaningful health reform.