We’ve been a little light on health care coverage this week. But to be honest, it’s probably not a bad thing that I’ve been out of the country. Any time I write about the public option — which appears have been sacrificed in pursuit of a health care deal — I generally wind up pissing people off.
But here, for the record, is what I think — and I think I’ve been pretty consistent in this thinking:
1) The energy by progressive activists on behalf of the public option has done more good than harm, and by a wide margin.
2a) Nevertheless, the public option is/was a relatively minor part of the health care bill, at least once it became clear that it (i) wouldn’t be pegged to Medicare rates, and (ii) would only be available to a small fraction of the population.
2b) To claim that a health care bill without a public option is anything other than a huge achievement for progressives is, frankly, bullshit.
3) Because of the symbolic importance attached to the public option on both sides of the debate, I’d tend to assume that it could be traded off for other policy goals at a relatively favorable exchange rate. That is, whoever “wins” the public option debate is likely to have traded some utilitarian benefits for some psychic income and/or longer-term tactical gains.
4) More specifically, in terms of the present compromise on the table, it seems to be quite clearly better than a bill without the Medicaid/Medicare expansion, the Franken Amendment, etc., but with a weak public option.
5) However, it’s not clear exactly what is really being traded for what. Perhaps the public option was never going to pass in the first place, and so all these new things are basically freebies for Democrats. On the other hand, perhaps if they had dug in their heels, the Democrats could have gotten both the public option and these other things. Also, the compromise itself will probably wind up being compromised, which makes it even harder to keep score.
6) The case that the White House failed to achieve a public option because it was inept is much stronger than the case that it failed to achieve one because it wasn’t progressive enough.
7) Liberals have tended to underestimate what a significant political achievement it would be for Democrats to pass such a major bill that has become rather unpopular with the public. It would be going too far to characterize the Democrats as courageous for passing health care reform (if they do), because at the end of the day, the political case for passing health care reform is probably stronger than the case for failing to do so. Moreover, the handling of public option debate is not completely exogenous from the bill’s popularity or lack thereof. Nevertheless, Democrats have been negotiating into a stiff political headwind for months now, and have been rather resilient in the face of it.
p.s. The headline should probably not be taken literally.