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People Power Matters: The Public Option Lives!

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In spite of the best efforts of the insurance industry and their followers in Congress and the media, it is still very possible that the health reform bill passed by Congress will include a robust public plan. This is a case where the simple facts and persistent grassroots pressure may overcome the political power of a major industry.

If the bill passes with a serious public plan, it could make an enormous difference for the future of health care in the United States. However, the fact that the public option is even on the table at this point, after all the political experts had counted it out, shows the enormous potential for popular pressure to influence policy debates in this country.

The basic story is that President Obama and the Democratic leadership in Congress had always been lukewarm in their support of a public plan. President Obama had included it in his original proposal, but has made it clear on numerous occasions that he did not view it as an essential part of his health care plan.

Of course, that is not the way that presidents get measures passed that they really want. President Clinton never said that he didn't view NAFTA as being a big part of his trade policy. President Bush didn't say that Congressional authorization of the Iraq war was a relatively small matter in his larger foreign policy agenda. President Obama's statements, that a public option was not essential, were an invitation to Congress to give him a bill that did not include a public plan.

This could have been the end of the story for a public plan, except for the determined efforts of progressive activists to insist that Congress include a public plan. While the plan's opponents argued that the leadership did not have the 60 votes needed in the Senate to end a filibuster, public plan supporters pointed out that public plan opponents did not have the 218 votes needed in the House to get a health care plan approved without a public option. The logic was simple, if progressive members in the House refused to back a health care bill without a public plan, then any health care bill that passes Congress would have to include a public option. A large coalition of progressive groups kept up the pressure, insisting that Democrats in the House insist that any bill include a public option. They bombarded members with phone calls, faxes, emails and staged protests and organized petitions. This coalition was helped by polls that consistently show a large majority of the public support giving people the option to join a Medicare-type public plan. In fact, a recent New York Times poll showed people supporting a public option by a margin of 65 to 26 percent. The same poll showed that overall health care reform package losing by a small margin.

Supporters of a public plan have also been helped by the facts. The Congressional Budget Office's analysis shows that a robust public plan, with rates tied to Medicare rates, can save $100 billion over the next decade. This is a substantial portion of the money needed to cover the cost of the health care bill. Given the popular support for a public plan and the evidence that it could save substantial amounts of money, it is clear that opponents of a public option are not responding to constituents or concerns over costs.

The sustained pressure from progressives seems to have firmed support for a public plan in the House, but there is still the issue of getting 60 votes in the Senate. Here, it is important to make a distinction that the media and political pundits have tried to hide. It is not necessary to get 60 senators who will support a public plan. It is necessary to get 60 senators who will allow the Senate to vote on a public plan. This is very different.

Until recently, filibusters were unusual. It was standard practice for a senator to support cloture - allowing a piece of legislation to come up for a vote - but then to vote against the bill itself. Filibusters were reserved for extraordinary issues that members of the Senate felt were especially important.

Currently, Democrats have 60 seats in the Senate. This means that the party just needs its members to allow the central piece of its president's legislative agenda to come to a vote. That should not require too much party discipline; after all, the senators could still vote against the bill itself.

It's too early to know if this "no filibuster" path will succeed, but the fact that a public plan is still in the mix is a testament to the ability of grassroots activists to move the national political agenda. The political insiders will do their best to deny it, but political pressure from the masses can and does make a difference. It has made a difference in the debate over health care and it can make a difference in other areas. Let's see what a little grassroots activism can do for the Wall Street banks.


24 Comments

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So, will anyone who's done a bit too much hand-wringing on this and who regularly drops notes here at the cafe own-up and admit it?

I have to allow, this has been much worse than living through a major election. (He's ahead. He's behind. No,wait...)

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As far as I'm concerned everyone patting themselves on the back for a game of kick the can. You Fing crazy if you think it going to lead meaningful change as is. It'll be thwarted but the Health for profit corps. The Zombies will have to be put down sooner or later and the longer you wait the harder it gets.

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Hmmm, let's not overuse the adjective "robust." This public option,says Joe Klein at Time, will be available to less than 5% of the population. To me a robust option would be available to anyone that wants it, whether they get insurance offered from an employer or not. Anyone should be able to dump the employer plan and sign up with the public option instead. This gets nowhere near that. It's a public option in that any insurance system seeded by the government is, but it ain't robust.

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Altogether now, repeat after Destor:

...a robust option would be available to anyone that wants it.
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Yes! Robust means an option available to anyone who wants it. Otherwise, as the singers pointed out just the other day to the insurance industry: "it's just a corporate giveaway."

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Agreed.

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agreed!

Reid hasn't even released exactly what his PO is, and the HELP option, according to the CBO does not bring down the price of premiums, yet, everyone is acting like Reid is championing a robust public option.


This is far from over.

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For those who have been critical of the President's supposed lack of leadership on the public option part of the health care debate, I am wondering why they believe that the White House's strategy, prior to the Senate Finance Committee's reporting a version of the bill out, wasn't just to avoid painting themselves into a corner on that matter?

If the President had "tipped his hand" by saying he would insist on a public option before Senate Finance reported out, isn't it possible this would have led to the effort dying in that Committee?

I think many at the site realize that a bill has to get voted out on majority vote from each of the Committees to which it gets referred, otherwise it dies. Senate Finance could have been the graveyard for health care reform. It's unclear that there was anything the President might have said that was going to persuade Max Baucus to include a public option in the bill his Committee was going to mark up.

If that indeed was the case, then the WH's leadership imperative was to cut that Committee enough slack that they would report out a bill, any bill really, so as to keep the effort from dying outright in that Committee. Once a bill was reported out of Senate Finance, options that were not in the cards for that Committee would be viable for the effort as a whole.

That said, I continue to share destor's concerns re whether a public option provision in what is being put together will be strong or robust enough to be effective.

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There's also the matter of Obama's relative unpopularity in many of the states from which the Blue Dogs hail. The harder he pushes for the public option the more it get associated with him and the harder it is for the Blue Dogs to vote for it.

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Gee, could race be involved here?

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Good point. I was just looking at some poll results reported in Politico for the New Jersey governor's race that show independents responding that, if they knew Obama endorsed the Dem incumbent, many more would be less likely to vote for that candidate than more likely.

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You are truly a dreamer....

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xavier12345, what do you mean by that?

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Oops, my bad, sorry xavier12345, question meant for Zeno of Citium, obviously...

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No way in hell anybody, that is, anybody is going to legislate and initiate a reasonably developed plan from the get-go. Creating a reasonble healthcare system in the U.S. is going to be an evolutionary process. The dismal economic aspects our current national health system has been at stasis for some time now. People like the "moderate" Sen. Snowe wanted to "move everything ahead" by adding what would have, at very best, been an extra evolutionary step. More likely, the trigger would have been a place of further paralysis.

Let's everybody take a minute and enjoy this small but genuine victory.

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Senator Ron Wyden was on Rachel Maddow's show tonight. He agrees with Destor that "A robust public option would be one that is available to anybody."

Watch the clip here: www.msnbc.msn.com/id/26315908/ . It's brilliant, and worth a few minutes of your time.

We've been bandying back and forth the phrase "public option" as though we understand what is actually being proposed. Now it the time to peek inside the black box to see how this particular public option is constructed. One thing's almost certain, the Senate bill will not be as good as HR3200, and HR3200 is not a public option for everyone.

Progressives have done a remarkable job of applying pressure to Democrats in the House, Senate and White House, and helping the public understand what's at stake. Tonight feels good, but the pressure needs to be redoubled in the morning.

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I'd like to see the evidence that this came from pressure from progressives.. Just asking not attacking. I want to know what pressure looks like so I can push to apply it even harder.

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It is true that People Power really matters. The decision of the majority always reigns than anything else. If we observe even in our homes the decision of the majority is being done so no matter what a person is influential it is useless unless the majority have give it's decision.

With regards to our government, even though we elected president who will reign in our country, it doesn't mean that all his decision must to be follow.We, citizens has our own rights to do whatever we want.

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"If we observe even in our homes the decision of the majority is being done..."

Not in my home. There are decisions in which the children are not competent to express an opinion, much less have a deciding vote. There are other decisions where outside influence is ignored, and the majority opinion of Americans is not allowed to intrude.
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With this stroke we've pretty much completed the process of officially dividing the health insurance risk pool in two: high-risk for the public, low-risk for private plans.

The public plans will cover the elderly, unemployed or underpaid, chronically ill and dying, while the private plans cover the relatively healthy and relatively well paid.

The public sector is prohibited from competing for business in the low-risk private pool. The private sector is allowed to compete for a small portion of the high-risk public pool (whee!).

I'm glad the Senate can say "public option," but there is only one risk pool for health care that makes sense, and that is "everyone."

Unless the public option is available to everyone, private plans will continue to game the system and the role of public competition in improving the quality and reducing the costs of health care will be minimal.

That's why Medicare E should be a public option available to everyone.

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Red Planet, if that is the way things shake out in a final bill I believe your analysis will be dead on.

Forcing people who don't have money to pay up front for premiums and herding the most expensive to insure people into the public plan would mean such a bill would not be a net improvement on the status quo, much as it is hard to believe we could do even worse than the dreadful status quo.

If something like that passes, I believe it would blow up in the faces of those who voted for it, and possibly even some incumbents who voted against it, as there will be a major backlash at the polls.

For elected officials who are planning on voting for such a bill and think it will automatically ingratiate them among many they've been hearing from on public option if something that is called "public option" is in a final bill...well, I think we ought to expect our elected officials to think things through more than that, and not fool themselves into thinking the affected public won't ultimately judge by the results they experience.

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It is interesting to note, what we have now is a subsidy to private insurance. We've taken the most "at risk" group out of the pool with Medicare(which, BTW, is flawed and underfunded.) As a senior under Medicare age and with "group", my annual prem is still two arms and a leg. I like to show that to my older friends and ask them what they think they would be paying if they had to go to the private market.

Any divies of "the pool" need to be carefully thought through. Heck, those that do that may even realize, we're all in this together.

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I'm so angry at this public-option-for-10%, the lousy work the legislature is doing on health reform, energy, banks, everything, I ranted on and on and had to blog it. What we have is a massive epidemic of co-optation, and I am so sick of it, after working so hard and so long in 3 states for 2 years for real change. Read it, if you would. It's my first blog here, and I'd like feedback. http://tpmcafe.talkingpointsmemo.com/talk/blogs/vcubed/

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Of course public pressure works, and getting this far toward a Public Option in spite of obvious opposition is another shining example of this. The problem is that change against corporate interests by the public is always slow and we are impatient by nature. I do think that a sleeping beast has been awoken in America, which contrary to the televised opinion, is not made up of disenfranchised right-wing teabaggers. It was 9/11 and the ensuing right-wing wet-dream that really woke the previously apathetic non-election-participating beast. The unpublicized truth is that the real majority in America is mostly "liberal", however the majority in America before the Bush debacle didn't vote at all. Now I see an America that votes and that is a boon to Liberal causes sure to disenfranchise the loud squeaky-wheel of a right-wing minority. This is an exciting time to be alive no doubt thanks to the enlightenment of the Internet, which has become the graveyard for awful demonstratively wrong right-wing ideas. So keep signing those petitions, and voting folks. It looks like one more good Senate/Congress election sweeping by the newly awoken beast ought to do it.

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