The Day After the Public Option Died

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Progressives are sad. It now appears that the public option will be stripped out of the Senate health reform bill. Joe Lieberman said he would filibuster legislation that included a public option, so he is the villain of the moment, but other key senators – including Democrat Ben Nelson – had also voiced strong opposition to a government-run insurance plan.

The public option was never a sure thing, but its apparent death this week has hit liberals especially hard. This is because they were hoping if they lost the public option, their consolation prize would be an expansion of existing public programs. In the past week, there was talk of expanding Medicaid to include all Americans earning up to 150% of the federal poverty level. There was talk of allowing Americans 55-64 the option to buy into the Medicare program. This raised expectations. And now progressives will likely get no prizes and no public option. But does that mean they should oppose the Senate bill?

In the harsh light of today, at least two influential progressive health care bloggers are urging their readers to resist the urge and instead, take a deep breath, mourn the public option (quickly), and be grateful for what’s left of the Senate health reform bill.

Here’s Ezra Klein of the Washington Post this morning:

The core of this legislation is as it always was: $900 billion, give or take, so people who can’t afford health-care insurance suddenly can. Insurance regulations paired with the individual mandate, so insurers can’t discriminate against the sick and the healthy can’t make insurance unaffordable by hanging back until the moment they need medical care. The construction of health insurance exchanges so the people currently left out of the employer-based market are better served, and the many who will join them as the employer system continues to erode will have somewhere to go….

…A lot of progressives woke up this morning feeling like they lost. They didn’t. The public option and its compromised iterations were a battle that came to seem like a war. But they weren’t the war. The bill itself was. When liberals talked about the dream of universal health-care insurance 10, 20 and 30 years ago, they talked about the plight of the uninsured, not the necessity of a limited public option in competition with private insurers…

…On its own terms, the bill is the largest social policy achievement since the Great Society. It will save a lot of lives and prevent a lot of suffering. But moving forward, it also makes future improvements and expansions easier. A lot of the hard work of health-care reform — in particular, the money for subsidies — will finish this year. If reformers want to come back for the public option or more subsidies in a future year, they won’t be doing it atop a $900 billion price tag that’s being battered by tea parties and industry and everyone else. This bill doesn’t have all the good stuff it should have, but reformers can stop fighting for what good stuff it does have and concentrate more intently on what good stuff is left to achieve.

And here’s Jonathan Cohn of the The New Republic in a post titled “What Public Option Supporters Won”:

Disappointed progressives may be wondering whether their efforts were a waste. They most decidedly were not. The campaign for the public option pushed the entire debate to the left–and, to use a military metaphor, it diverted enemy fire away from the rest of the bill. If Lieberman and his allies didn’t have the public option to attack, they would have tried to gut the subsidies, the exchanges, or some other key element. They would have hacked away at the bill, until it left more people uninsured and more people under-insured. The public option is the reason that didn’t happen.

And if public option supporters lost in the Congress, they won in the country as a whole. The underlying political problem for liberals remains what it has been for a generation: profound and widespread distrust of government. But polls consistently showed voters thought the public option advocates were right–that, at least when it comes to health insurance, government can be trusted. It was a small victory, but it’s on top of such small victories that political movements are built. Someday in the future, that movement may be powerful enough to win more sweeping changes. Who knows, maybe those changes will include a government-run insurance plan.

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