The Public Option Option Option
So, perhaps you've heard the buzz about a shiny, new compromise compromise in the battle for healthcare reform reform. First, there was the notion of single-payer. Of course, this proved to be far too unpalatable for anyone to the right of Dennis Kucinich, so then we were given the notion of the public option. This would create a Medicare-style system for anyone who wanted to buy in. It was certainly a compromise, but the merits of the compromise, as well as the general notion, were clear - it's publicly run and anyone can opt in. Public. Option.
Of course, then came the deluge of counter-offers and distortions. It quickly became the "government option" or "government takeover of healthcare" or "Barack Obama wants to kill your grandmother by way of ripping your children to shreds and force-feeding her to death with the pieces like the Sloth guy in Se7en." Oh, and the further compromises. For some, the public option was still not enough of a compromise, so it needed to be sliced up into 50 parts or converted into regional co-ops or hooked up to triggers.
That gave rise to the notion in the House of the "robust" public option, otherwise known as Public Option Original Scent. While Ms. Pelosi has insisted that the People's House will most assuredly go all robust on your ass, the floundering in the Senate, aka the Keeper's House, has taken center stage, which has pretty much looked like deja vu all over again circa 1994, with characters like Max Baucus doing their best to scuttle reform while raking in contributions from the healthcare sector hand over fist.
But, hark, what's this? Rumors abound of Senate Democrats proposing an "opt-out" version of the public option whereby states could individually decide not to participate. Even though the White House and Congressional leadership have little to say about the proposal, the raving, left-wing, liberal blogosphere has already given it the stamp of approval, with everyone from Josh Marshall to Ezra Klein to Nate Silver pretty much giving it the thumbs up, mostly on the basis that it gets us most of the way there and could be a likely pathway to getting all the way there.
They could be right. However, there's one thing about the public option option that is just obvious crap, which is this: It was already an option. What the "opt-out" clause would do is allow states to effectively bar their citizens from participating in the plan. Why should this be done? Ostensibly because their politicians aren't willing to go along with Public Option Original Scent. But the left-intelligentsia has ruminated on this and decided that the hold-outs will have to come along eventually, so it's just a matter of sooner or later.
However, there are several interesting things to note here. One is that the public option gets its power from numbers. The bigger the pool, the more powerfully risk distribution and collective bargaining can be leveraged. When you shrink the pool, you inexorably shrink the effect of these tools. Shrink the pool too much, and the public option becomes powerless. That, after all, is the motivation behind shilling for demonstrably poor systems like regional co-ops. Those who favor co-ops know they won't be very effective.
Furthermore, it's almost certain that the opt-out states will be red states with smaller populations and uncompetitive insurance markets, like Max Baucus' Montana. These are arguably the people who need healthcare reform the most because they literally have as few as one company from which to purchase insurance in some cases. You'd think the Mickey Mouse Club Freemarketeers would have knives out for such markets. Of course, they don't, but this doesn't change that, as a matter of policymaking, leaving the people who need reform the most out in the cold isn't exactly the moral thing to do.
Then again, it's likely that this is less a matter of policymaking and more a matter of positioning, such that the process can move past committee through a floor vote and into conference where a filibuster in the Senate isn't the lynchpin. That might be the case, but it even seems weird as a matter of positioning. Think of it this way: The red staters that won't get on board with a public option, which is intended to give their constituents choice, will supposedly be appeased by being able to deny them choice. Huh? I thought the state's rights issue was all about protecting the little guy from the big, scary federal government, not telling him that he can't have something that most other citizens have been given as a matter of federal law.
Of course, it isn't lost on me that the state's rights mantra has more often been used to deny people their liberties, like civil rights and access to abortion, than it has gone to defending citizens against the trespasses of the federal government. So, this is really in keeping with that tradition, but how do they sell this to their constituents? You can sell denying civil rights to minorities when your constituency is mostly white and at least somewhat racist. You likewise sell denying abortions to women if your constituency is predominantly godfearing. But how do you tell your constituents that you're going to fight to deny them choice?
In that sense, JMM, Klein and Silver might have a point. If this gets the votes and is a political impossibility to sell to people back home then it might end up being a win, at least in the long run.
But by this time, all of this political hokey-pokey has my head spinning. It's started to feel like some sick version of one of Zeno's paradoxes, where we'll somehow be able to achieve our goal by constantly cutting the remaining distance in half. After all, people are seriously talking about a proposal to opt-out of an option. If that doesn't start to get surreal, I don't know what does. Is Joseph Heller pulling the strings somewhere?
Seriously, I'm waiting with marked anticipation for the next compromise compromise. What will the public option option option be like? Anyhow, I'm hungry. For some reason I feel like pizza pizza.
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Cross-posted at dagblog.com, where you can get your scissors sharpened for half the price!
















Wish you hadn't mentioned pizza---now we get the stomach-fat ads.
It's always been Nullification, from slaves to gun laws to busing to Social Security to gay rights and the economic stimulus. Some folks just don't want to admit they benefit from the existence of the rest of us.
Medicare is (mostly) popular since most of us know it would be hard or impossible to get any kind of new policy after retirement. But too many think they shouldn't have to contribute a nickel for someone else's health problems. They likely find it hard to understand that the crappy job they have at Wal-Mart is dependent on those customers that aren't too sick to earn some money, and that can come to the store and buy clothes or food. Without everyone else, we're all broke.
October 9, 2009 5:22 PM | Reply | Permalink
Glad you cross posted this. I see the political calculus here but, damn, seems like we're always playing politics games. We need to be covering people.
October 9, 2009 9:11 PM | Reply | Permalink
Thanks for writing this blog... now I can vent how absolutely GD pissed off I am about this!!!
Pushing the fight for a public option on further into every state... leaving it to blow like the wind politically and letting the citizens of each state fend for themselves ongoing... WTF!!!
And Howard Dean is on board... Give Me A Freakin' Break!
This is just another gimmick and another way for the Senate to screw us in a new fashion so that they don't have to face the real confrontation of an up or down vote on a true public option.
I have contacted my reps and told them I don't want to see anymore GD gimmicks, triggers, Cantwell amendments pitting state against state (not the right way to create competition), I don't want any trap doors and secret covenants...
I want a true public option that cuts costs and is available to all Americans, preferably before 2013.
Congress has 'highly' overestimated the willingness of a majority of Americans to accept a mandate without a true public option...
I think they are just finally starting to realize this.
I think that may be why you hear some republicans suggesting some others get on board some how.
A bill without a true public option will not fly with the majority of American people no matter how much the insurance companies spend to try to buy off our reps.
I suggest everyone write to your reps and tell them no games, no gimmicks, no tricks... just a true public option that cuts costs and is available to all Americans.
Thanks for the opportunity to vent:)
October 9, 2009 10:25 PM | Reply | Permalink
Thanks for smartly slicing into the dark heart of the absurdity that distances the public option further and further from the public and makes it less and less an option at all. Something is terribly, terribly wrong with this picture. Great post. Rec'd.
October 10, 2009 10:58 AM | Reply | Permalink