Is it time for progressives to push the reset button yet? The strategy of supporting the Public Option idea in hopes that Republicans, Conservatives, Blue Dogs, and the health insurance industry would be more friendly to it than they would be to a Medicare for All Government Health Insurance Plan has certainly failed. The opposition to the PO is every bit as hysterical and intense as we might have imagined it would be for Medicare for All. However, in supporting it, progressives have certainly sacrificed the clarity of their ideas and legislative proposals and also the enthusiasm of supporters of health insurance reform who still believe in Medicare for All. So, now entering the days of climactic conflict over health insurance, when Democrats must rely on the progressive base of the Party to pressure Congress into voting for a worthwhile health insurance industry reform bill, that base is hanging back, reluctant to enter the fight.
The problem is that the Administration, the Party, and various progressive organizations working with them, want the progressive rank-and-file to go to the mat for weak bills that they don’t believe in and are not excited about. The public option may have been the compromise that progressive organizations such as HCAN, DFA, and Move-on agreed to months ago, but the POs in the Senate HELP bill and HR 3200 are absolutely not what anyone originally had in mind when the PO was first proposed By Jacob Hacker, and when the progressives agreed to support a bill with the PO as its central feature.
Both those bills will be operational and political disasters, if only because even the inadequate and constrained in eligibility PO and exchange proposed in both won’t be available until 2013. To follow a new strategy that has a much better chance of success, progressives must reset the conversation. They must forget about the PO and go back to supporting Medicare for All and only that in Town halls, demonstrations, meetings with Congress, articles and blogs, social networking communications, and any other promotional settings. Maximum effort must be made to pressure Congress to get HR 676 through. The Progressives ought to compromise with the President and the blue dogs only after HR 676 is defeated, and only on a minimalist strategy implementing three separate bills with the following content and in the following sequence:
1) Establish a public component to compete with private insurance, and put it into operation within a year of passage of the bill. This can be done by extending both Medicare and Medicaid eligibility to everyone under reconciliation, and balancing off the cost by having people under 65 buy into it, and by raising taxes on those with incomes over 250,000. This will take 50 votes + 1 VP vote in the Senate to pass. The need for 50 + 1, rather than 60, will make it much easier to get this, than it is to get a comprehensive bill. Nevertheless, it will still be very difficult to pass this, and I think the only way to do it is for progressives to make clear that no other health insurance reform bill will pass because they will block it, and that without a reform bill, the chances are very good that many blue dogs, their health insurance industry and Pharma contributions notwithstanding, will be defeated in 2010, but not many progressives, because the latter will be voting for what constituents in their relatively safe districts want.
2) Eliminate the worst insurance company abuses, such as denial of coverage based on preconditions, raising insurance prices for those who have become ill, and rescissions. This will take 60 Senate votes in a separate bill, but would be hard for any Democrat and even a few Republicans (Snowe, Collins, Voinovich, Lugar) to vote against. It’s hard to see how this one could fail, if it were brought to an up or down vote.
3) Create an exchange, providing subsidies for individuals and implementing mandates for them, but not for businesses. This will also take 60 votes, but it is the piece the insurance companies will really want, especially if 1) and 2) have been passed first. On the other hand, progressives in both houses will be much less interested in this than they are in the first two. They’ll be interested in the subsidy part, but not really in the other two. The middle course for the blue dogs is to vote for 1) in return for progressive support on 3). Once 1) and 2) are in the tank, the insurance industry will throw its weight behind 3) so it should get a lot more than the 60 votes needed.
The operative effect of these three bills will be to produce a robust PO along lines of the original PO proposal. This will not be as desirable for progressives as Medicare for All, because private insurance companies will still exist, and will still be driving up national expenditures on health insurance. However, it will still produce a path toward Medicare for All and also the ability to “bend the cost curve” since private insurance companies will have to compete for customers against a public insurance system that will be charging Medicare rates and will be using Medicare’s private network. This will either make the companies compete by lowering their rates, or offering much superior services. They can also, of course withdraw from the business of providing insurance for basic health care services. Which alternative they select is up to them. It will be a matter of “free enterprise” acting in its own interest.
(Also posted at firedoglake.com where there may be more comments)