It Is Possible To Pass A Public Option Now

by: Chris Bowers

Mon Aug 31, 2009 at 11:00


In both branches of Congress, Democrats already have the votes and procedural options in place to pass a public option on health care reform. This means it is possible to pass a public option now. It also means that if a public option does not pass as part of health care reform, it will be a because of a political calculation made by the Democratic leadership, not because there was no way to pass one.

Reconciliation Flexible for the Public Option
Despite what Democrats such Kent Conrad, Jim Cooper, and George Stephanopoulos are saying, it is entirely possible to pass a public option through reconciliation in the Senate. As budget expert Stan Collendar wrote two weeks ago, determining what can be passed through reconciliation is a bit of a gray area open to some degree of interpretation:

As I said, this is complicated and will be extremely controversial.  There are budget experts on both sides of the aisle and this is more of a judgment call than the application of a hard and fast rule.

One expert arguing that a public option can be passed through reconciliation is Martin Panoe, who served as Secretary for the Senate Democratic caucus from 1995-2008. Last week, Panoe said the following:

"If a public plan is shown to have a cost to the government that affects outlays or revenues, it could be included in a health care bill using reconciliation procedures," said Martin P. Paone, a former Senate aide who has been consulted by Senate Democrats.

Given that there is a range of interpretation when it comes to the use of reconciliation in the Senate, and that at least one of the leading experts on Senate process believes that a public option can be passed through reconciliation, then it is at least possible to pass a public option through reconciliation. The idea that 60 votes are absolutely required for a public option simply isn't true.

Majorities In Both Branches Of Congress
As far back as April 30th, 235 members of the House of Representatives were in favor of a public option. This number is well over the 218 needed to pass  a bill through the House.

According to our latest Senate whip count, 44 Senators are on the record in favor of a public option.  Further, Max Baucus has recently claimed that he wants a public option, and Senators Mark Warner and Ron Wyden have said they will vote for one if it reduces costs. Both Jon Tester and Mark Pryor have said there are public options they could support. Tom Carper has said that he doesn't care if there is a public option or not, and Blanche Lincoln has said that people should have the choice of a public option.

Overall, there are at least 51 members of the Senate and 235 members of the House who have said they are open to some sort of non-co-op public option. Further, there are at least 60 members of the Senate who have not ruled out a public option. This means that there are enough supporters of some sort of non-co-op public option to make a majority in both branches of Congress.

Conclusion: Public Option Being Held up By Political Calculations
It is possible to use reconciliation for some sort of non-co-op public option, and to find a majority in both branches of Congress for some sort of non-co-op public option. As such, a public option currently has not been passed because of political calculation, not because Democrats have no other choice.

Here is the choice:

  1. Pass a public option in health care reform, either using reconciliation or convincing some Senators to vote for cloture even if they don't vote for the final bill. The methods required to do so will cause damage to the Democratic congressional leadership and Obama administration's attempts to look bipartisan. Private health insurance industry groups will likely severely hold back donations, and target quite a few "moderate" Democrats in swing or Republican-leaning districts.

  2. Don't pass a public option in health care reform, either by trying to force the progressive block to fold or by passing nothing at all. This will probably mean fewer uninsured people are provided insurance, and that health care costs neither stabilize nor reduce their share of GDP. Further, progressive grassroots blowback will be immense, at least by the standards of progressive grassroots blowback.
This is a choice. Democrats can pass a public option if they want to. If all goes awry, don't let Democrats tell you after the fact that they had no other options. Tell them that there was a viable path to the public option they could have followed, but they chose not to follow it for political reasons.
Chris Bowers :: It Is Possible To Pass A Public Option Now

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Agreed, and a little White House support would help, too... (4.00 / 4)
Just a little White House support from Obama to move away from this Gang of 6 approach and promote a cost reducing public option, might be all that it would take to get the Senate count over 51.

Obama really needs to get out front on this and provide the leadership to get this done.  It is really is on the Dems to make this happen, not on some "gang of six" who have shown zero progress in many months toward any meaningful solutions to these health insurance issues!  


It will take a lot of WH... (4.00 / 2)
In fact, if Chris is right, it's all on Obama to push the public option past the finish line.

John McCain won't insure children

[ Parent ]
I like this line (4.00 / 6)
progressive grassroots blowback will be immense, at least by the standards of progressive grassroots blowback.

In fact, I think blowback among Dems would extend beyond the grassroots.

My assumption is that Obama is kinda-sorta ready to pass a bill with a PO through reconciliation but is concerned about polls showing support for health care reform tanks if it's passed only by Dems. So what he's trying to do is to pick off one or two Republicans in the Senate and a handful in the House (Good luck!)) or short of that, to look bipartisan as long as he can. At a certain point he has no choice but to pivot and start blasting Republicans for being obstructionist and opposed to reform, period, and at the same time, it'd be nice if he started explaining to the public what a PO is, cause most people don't know. That is, explain what he's for and what the other side is against.


It would be nice if that came to pass. (4.00 / 2)
8 months into his presidency, we still don't know where he truly stands.  Too many games.

Deals seem to appeal to Obama more than a real fight against power.

Hillary Clinton accepted the corrupt system and argued she could deal with it and get a better outcome.  Obama hired Rahm and chose the Clinton road.  Accepting that we are not a democracy and dealing with the owners of many Senators and House members.  PhRMA, big insurance, etc.

I hope you are right that he will fight, but I've yet to see it.


[ Parent ]
Well, I must admit (4.00 / 2)
that what I just wrote contradicts what I've been arguing for weeks: that Obama is calculating, reasonably, that passage of a bill without a PO will be hailed by the MSM as a MAJOR VICTORY, and many progressives--Yglesias, Klein, even Krugman--will concur. The Obama hardcore will fall into line, leaving half the base to complain. The cost of not passing a PO isn't quite high enough, not yet, although as I suggested up top, Dems beyond the activist base are starting to worry that Obama doesn't have much fight in him--their disapproval is a potential counterweight.

There, having argued both sides of the argument, I'm covered.


[ Parent ]
Although I agree with the need as stated above of Obama leading (0.00 / 0)
I do not see the pledge block folding, and it would require the pledge block folding for this to happen. Centering on Obama in this, and remember, I agree of the need for leadership as cited above, doesn't just miss whats going on, but what should be going on.

1) Its the House of Representatives were this battle is being waged. The President is The President, and super sexy and holds dreams easier than Ojibwa  Dream Catcher, and the Senate has plenty of infuriating weasels, but in truth, the battle that we are fighting is on the barricades of the line in the sand pledge. Hold that line and we win the war.
2) We should be doing more. First we should be following desmoinesdams well thought out and well presented advice to bring the populist caucus on board, we should be out organizing with Dean's Democracy for America, and we should be electing, promoting and developing more better Democrats.
3)Our job should always be, no matter the problem, is orrganizing the public to make demands that can't be ignored, while removing obstacles to them being implemented.

You are not wrong about how much it would help our efforts in getting the bill passed if Obama would, and could, press so hard himself that it just happened. I am not sure help do what we still, and always been obligated to do: create an engaged demanding literate democratic progressive citizenry.

--

The government has a defect: it's potentially democratic. Corporations have no defect: they're pure tyrannies. -Chomsky


[ Parent ]
LOL! (0.00 / 0)
You'd make a good lawyer.  :-)

If you can get fees for arguing both sides.  :-)


[ Parent ]
I think (4.00 / 2)
the real battle will now be over financing and tax increases.  The PO fight has essentially been won.

The GOP's main goal is to keep any bill from passing.  My guess is that there will be significant focus on the tax increases necessary to make the program deficit neutral.

Of course, the CBO showed how to pay for Health Care Reform last week.  Go to page 40 of the latest budget summary from the CBO which is here.

Here is the first line on that page.  Note that the amount saved would be equal to the cost of health care reform.  


what kind of public option? (4.00 / 2)
The HELP bill creates a very weak structure compared to HR 3200, which creates a weak structure compared to the other House draft bills. If the final bill looks like the HELP bill, we will have overpromised what the public option can deliver for people.

Join the Iowa progressive community at Bleeding Heartland.

[ Parent ]
The devil (4.00 / 1)
as always is in the details.  Frankly I don't know the ins and outs of the PO well enough to comment.

I have always thought, though to some extent a PO will always succeed because the private insurance companies will want the PO take the patients who are chronically ill and are therefore less profitable.  

Alas, I am no Health Care Economist....


[ Parent ]
As usual by: desmoinesdem plants the good one. (0.00 / 0)
The question we should be asking now, and asking of the pledge block, is has the pledge minimum changed, has the line moved left now that e have won this battle, is the art of the possible redrawing the reform and PO so that it covers more, starts sooner, is more robust saves more money make shte system more viable and pushes the private insurers even closer to sanity if not empathy.

The battle is not in the Oval office, the battle in congress, in the house, and that is where it belongs, and that is were we should be concentrating our efforts.

(I am not exempting Obama, I am placing him more accurately in the struggle)

--

The government has a defect: it's potentially democratic. Corporations have no defect: they're pure tyrannies. -Chomsky


[ Parent ]
"Deficit neutral" is an obvious FAIL (4.00 / 1)
As Avedon said:

[A] "deficit neutral" plan is a failure; a good plan would actually cost less than what we have now. And if the Dems are going to ignore the Republicans and the Gang of Six (as they should), there's no need to pass a watery bill that doesn't do enough and costs more than it should. Single-payer is the fiscally responsible plan, so let's have it.


I am in earnest -- I will not equivocate -- I will not excuse -- I will not retreat a single inch -- AND I WILL BE HEARD.  

[ Parent ]
"Deficit neutral" my attentive friend includes citing which taxes need to be raised (0.00 / 0)
in order to pay for the increased costs.

Adding a tax to people who make more than 1.5 million dollars a year to cover any increased costs of the subsidized portion of a public option is revenue neutral.

--

The government has a defect: it's potentially democratic. Corporations have no defect: they're pure tyrannies. -Chomsky


[ Parent ]
Thanks for making my point even more forcefully (0.00 / 0)
n/t

I am in earnest -- I will not equivocate -- I will not excuse -- I will not retreat a single inch -- AND I WILL BE HEARD.  

[ Parent ]
You're welcome of course. (0.00 / 0)
It would be easier if the point was made in the first place. Did you forget that the discussion in the house is centered exactly there? That the final Bill will probably cite just that? Though there are discussions on other funding models. That is why discussions about the final bill are necessary and support for solutions built.

I like taxes on health cripplers like cigarettes too, but I am sure it wouldn't be enough, and it promotes a new criminal class when the tax gets high enough, and new criminal classes promote social break down.

The amount of cigarette running is increasing, and I know lots of people, lots who regularly buy their cancer sticks from thieves. People who would report someone who had a truck of new laptops for sale for 100 bucks hand over hundreds of dollars to avoid cigarette taxes.

--

The government has a defect: it's potentially democratic. Corporations have no defect: they're pure tyrannies. -Chomsky


[ Parent ]
Continued obfuscation (0.00 / 0)
Let me repeat the money quote, which you have managed to obscure:

[A] "deficit neutral" plan is a failure; a good plan would actually cost less than what we have now.

Of course, when "progressives" take single payer -- and its $350 billion a year of savings (minimum) off the table, they're reduced to arguing irrelevances like cigarette takes, "deficit neutral," "revenue neutral," etc.

I am in earnest -- I will not equivocate -- I will not excuse -- I will not retreat a single inch -- AND I WILL BE HEARD.  

[ Parent ]
The sad thing is (0.00 / 0)
that even if they do manage to get the Public Option through by whatever means (and depending on the form it takes), it only has the potential to address a fourth of the problem with the U.S. health care system. And unless those other 3 areas - 1) doctors & hospitals, 2) pharmaceutical manufacturers and 3) equipment & supplies manufacturers - are addressed, there is nothing to stop the continued rise in health care costs from exploding and turning public insurance into a financial sinkhole, just like private insurance.

I am afraid this is true, very true. However it beyond the scope of this reform. (0.00 / 0)
Canada does not deal with these problems in full now in any significant way, for example. Another set of reforms, round the world, and consisting of changes on many many spheres will need to be made in an ongoing and continuous manner.

Just as one example, there are drugs that cost multi thousands of dollars to use for one treatment, several hundred thousand dollars for a complete course of treatment. Not because it cost that much to make, or even top recoup development costs. Many of these drugs were developed, niot in private labs, but in the federal govt's NIH, and at government funded Universities.

I am tried of it. It doesn't work. But this set of reforms will not cover it.

This set of reforms is making sure that people get healthcare,  and making the first few stabs at reducing waste and unearned profit.

--

The government has a defect: it's potentially democratic. Corporations have no defect: they're pure tyrannies. -Chomsky


[ Parent ]
Well, except for those not covered at all, of course (0.00 / 0)
"Progressives" long ago ratcheted down "universal" to mean "a really, really high percentage."

I am in earnest -- I will not equivocate -- I will not excuse -- I will not retreat a single inch -- AND I WILL BE HEARD.  

[ Parent ]
So, why is the scope so constricted? (0.00 / 0)
If we don't have to worry about the Republicans (not that we ever needed to, but it took awhile for some to figure that out), and if we can do whatever in reconciliation, why on earth are we trying to limit the scope, instead of maximizing it to, ya know, a solution that might actually work?

[Where "work" is defined to mean something other than bailing out the insurance companies with the mandate, that is.]

I am in earnest -- I will not equivocate -- I will not excuse -- I will not retreat a single inch -- AND I WILL BE HEARD.  


[ Parent ]
Shall I send you papers that inCanada are where the debate about healthcare reform lie? (0.00 / 0)
In Canada the discussion about health arew about "The Determinants of Health"

http://www.chsrf.ca/final_rese...
http://www.policynote.ca/2009/...
http://www.phac-aspc.gc.ca/ph-...
http://www.genderandhealth.ca/...

Housing cannot be separated from health, education, income level and daycare services are where the front line in health reform stands now. The social changes necessary to ensure that citizens are not denied the conditions that promote health. I am sure you want these included in this Bill too.

Should we talk about making sure that Health is delivered only through public institutions as is demanded by the NDP? A public health system, I am sure you agree means the nationalization of Hospitals in this Bill too.

Or maybe health reforms should done on a step by step basis, letting the reform fit American values, American experience as driected by Americans? Lets get "a really, really high percentage" covered and have a robust public option, deny pre-existing condidtions as a way to deny coverage and while not resting on laurels, appreciate the foundation before starting in on the support walls and roof.

--

The government has a defect: it's potentially democratic. Corporations have no defect: they're pure tyrannies. -Chomsky


[ Parent ]
Easy for Canadians to say... (0.00 / 0)
... when they've got a system that actually works.

Rather than trying to change the subject, how about you send me some papers that show how your "really really high percentage" so-called plan would actually work? In detail?

Because so far as I can tell, "progressives" haven't got any laurels to rest on whatever -- unless you count helping the adminstration take single payer off the table with their bait and switch operation on the pissant public option as a laurel, of course.

I am in earnest -- I will not equivocate -- I will not excuse -- I will not retreat a single inch -- AND I WILL BE HEARD.  


[ Parent ]
Great post, thanks. (4.00 / 3)
I don't want to hear any more excuses from the leadership. Let's get this thing done.

Montani semper liberi

Good post, Chris. (4.00 / 3)
Too many are more desirous of insurance company cash than are afraid of us.  We need to make examples.  It's not winning a primary, as we did with Lamont.  It is defeating an incumbant.  It's nice but not necessary to replace the incumbant with a more progressive Dem.

They need to fear us.  Until then, we will get lip service and then screwed without even a kiss.


The power of a strong spine and strong conscience is here. (4.00 / 2)
Just to note that we have a group, standing with a conscience that says we cannot pass a bad reform bill. They have the power, our support is part of that power, its growth through our efforts is part of that power. They do fear us, because we are together in solidarity with people who drawn a line.

--

The government has a defect: it's potentially democratic. Corporations have no defect: they're pure tyrannies. -Chomsky


[ Parent ]
no, there is one other possibility (0.00 / 0)
the other possibility is that Harry Heid is an asshat. Maybe he is too incompetent to know whether he has the votes. Ever think of that possibility?

Speaking of cash... (4.00 / 5)
See Krugman today.

* * *

Which public option are we talking about? The original, Medicare-style "public option" with 130 million enrollees, or the pissant HR3200 public option with only 9 or 10 million? Details do matter.

Unfortunately, "progressives" have allowed the discourse to degenerate to a series of vague gesticulations and ritual incantations, including "public option," "robust public option," and "strong public option," without making any effort to say what they mean in policy terms.

Leading to the not unnatural suspicion that the whole fight is about declaring victory in time for the mid-terms, rather than achieving it.

I am in earnest -- I will not equivocate -- I will not excuse -- I will not retreat a single inch -- AND I WILL BE HEARD.  


France? (0.00 / 0)
The American healthcare debate is skewed. It should be devoting more time to changing U.S. culinary and eating habits in ways that cut the need for expensive care by reducing rampant obesity, to which anxiety, haste and disconnectedness contribute. France has much to teach, guts and all.

I think you meant this

[ Parent ]
lambert is exactly correct, again. (0.00 / 0)
This is the battle, it is being foyght right now, in the congress, the people who are fighting are the ones in the line in the and members of the Progressive and Populist(who have signed on) Caucuses, and their allies. This is where the battle is being fought: the actual delineation of the Bill that will go forward, and what the "Robust" means.



--

The government has a defect: it's potentially democratic. Corporations have no defect: they're pure tyrannies. -Chomsky


[ Parent ]
You mean people have been whipping for "robust" for months... (0.00 / 0)
... without a clear understanding of what it means?

Seems to me that my scenario, that the vague "robust" is just a way to declare victory in time for the midterms, is just as plausible.

I am in earnest -- I will not equivocate -- I will not excuse -- I will not retreat a single inch -- AND I WILL BE HEARD.  


[ Parent ]
Oh lambert, your chiding tone is adorable (0.00 / 0)
As I am sure people can check themselves, the Progressive Caucus, our Heroes in the Congress, have drawn a line in the sand, and its fairly detailed, but not as detailed as 1200 pages of legislation. Detailed enough to trust their intentions and thank them for saving the public option, detailed enough, sop that now we can start a discussion on taking that as the base for the final talks on the reconciled Bill.

This is where the struggle lies, this is were the details will be written. This is where the Rdward M. Kennedy National Health Act 2009 will be written.

--

The government has a defect: it's potentially democratic. Corporations have no defect: they're pure tyrannies. -Chomsky


[ Parent ]
Oh, puh-leeze (0.00 / 0)
Way to make common cause with the single payer advocates, there, HousesOfProgress [sic] But I forgive you, because you're so cute when you actually drop the pom-poms and try to do analysis. Baby steps!

Since you don't give a link to the "fairly detailed" line in the sand, and my telepathic facilities aren't at their best this time in the evening, let me ask you two questions on this "fairly detailed" plan:

1. How many enrollees do they project in their version of the "public option" (or plan)?

2. Will they permit state experiments with single payer? (The Kucinich amendment)

* * *

As far as the battle, this is the battle: To prevent the Dems from declaring victory in time for the midterms by passing a pissant public option that bails out the insurance companies and forces us to buy junk insurance with the IRS acting as the collection agent.

Oh, and since subsidy + means test = welfare, somehow avoiding framing public option as welfare and having to defend it from being cut for the next twenty years or so.

NOTE On the 1200 pages, you're confusing detail with obfuscation.  

I am in earnest -- I will not equivocate -- I will not excuse -- I will not retreat a single inch -- AND I WILL BE HEARD.  


[ Parent ]
Is this the same Krugman (0.00 / 0)
who two weeks ago said the public option really wasn't that important?

[ Parent ]
option 2b (0.00 / 0)
i've been wondering - what would be left if they stripped out the public option and individual mandates? presumably then you'd also cut out subsidies. are the insurance regulatory reforms (like no exclusion for pre-existing conditions, no recissions, etc) dependent on the mandate? politically, i mean, we know that logic has no part in this.

if you ended up with a bill that was just insurance reform, a kind of Kennedy-Kassebaum Pt II, it seems like it would be easier to pass through the House and also would not cause a big progressive backlash. it would be a waste of the political moment but it wouldn't be actively bad, the way mandates+no-ops or some such would be. would it?

not everything worth doing is profitable. not everything profitable is worth doing.


+1000 (0.00 / 0)
Yup.

A mandate that forces millions to buy junk insurance -- now that's the kind of "robust" an insurance CEO could grow to love!

Why not pass a modest reform package, then? Because the Dems can't declare victory with a modest reform package, that's why.

I am in earnest -- I will not equivocate -- I will not excuse -- I will not retreat a single inch -- AND I WILL BE HEARD.  


[ Parent ]
Alternative Possible Conclusion (0.00 / 0)
One or more of the Senators saying they could live with a public option are hedging, fudging, or lying. It wouldn't exactly be unheard of.

That said, getting at least 5 votes out of the 14 maybes -- 36% -- does sound eminently doable; only 4, 29%, if MA changes their law and a replacement for Kennedy is appointed in time.


There is no need to compromise: we are there (4.00 / 1)
A good Democratic position on compromise

You don't compromise just for the sake of compromise.  You don't compromise just to make a pretty package.  You compromise only when you have to..... after you have exhausted all other ways.  And of course that the compromise itself is still worth having.  

And as Chris has made plain what all of us know...THERE IS NO NEED TO COMPROMISE. We don't have to this time.  There is a path to victory this time.  A public option can, should and will be in the final bill.

You don't compromise on important, fundamental principles.....especially when you actually can get them.

"Incrementalism isn't a different path to the same place, it could be a different path to a different place"
Stoller


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