The Future of the Public Option
What’s wrong with the progressive block strategy? For one thing, it’s not clear that the threat is credible. Technically speaking, the bill that the House passed did not contain what had initially been defined as a “robust” public option — meaning one pegged to Medicare rates. But only one or two progressives wound up voting against it for this reason, even though many had threatened to do so.
Medicare reimbursement was never going to happen, and it was never anything we asked for in our whip count (have a look at our initial June 23 post). And we didn’t ask for it expressly because of the history of the issue.
It wasn’t something that Earl Pomeroy pulled out of his ass just to stop the public option. As the co-chair of the House Rural Health Care Coalition, Pomeroy had been fighting for adjustment to Medicare rural reimbursement rates for years. H.R. 6030 had 85 cosponsors. There were enough Democrats who didn’t want health care passed in the first place who were willing to take it down over this. Unless the progressives were ready to play hardball and start taking the ag appropriations bill hostage or something, it wasn’t going to happen. And the progressives just don’t have that kind of organization or unity at the moment.
Nancy Pelosi laughed at the progressives when they included Medicare reimbursement in the July 30 letter. I laughed at them. They gave it up 3 days later (August 2 I think). Their “good intentions” were never going to put it over the top.
I never believed the whip list that appeared in late October either, there were just too many people on it who weren’t credible. Forget about the Blue Dogs — all of the New Dems were going to screw the AMA on this? Every single one? Really? Somebody took a look at their PAC donations and believed that?
The truth is that members of Congress sign these letters all the time. They’re pretty meaningless, usually written by some lobbyist and frequently signed by a staffer — the member may never even know they signed it. They think nothing of going back on them. The fact that there was a big show at the end over Medicare reimbursement demonstrates that they woke up to the fact people were watching this time, and they had to do something to save face.
A public option, on the other hand, is now a bright line. Not the one I would’ve chosen, but the one that a small group of people with limited resources could exploit when they entered pretty late in the game to counter the $1.4 million a day being spent on the Hill in lobbying, to say nothing of the advertising and field efforts.
The whole concept of “medicare reimbursement” just never penetrated that deeply in the public consciousness. And to answer Nate’s question, that’s “why” the “public option” — people were attached to it thanks to Obama’s promotion of it, whatever they thought it meant. The history of modern American politics should be proof enough that you can’t wake up one day and decide to start working against that kind of machine and expect to have an impact just because you’re “right.” You’ve got to have an entry point, and that was one we felt we could use.
Regardless of what others may think, I measure our success based on what would happen if we did nothing versus what our impact has been. For our size and resources, that impact has been huge. Those who think we should’ve been able to “save” health care (or kill it, when there isn’t the political will to do so) are not realistically assessing either our resources or the situation at hand.
But are the progressives who have said they’d vote for a bill that doesn’t have a public option a credible threat? Well, that’s why we never counted on the July 30 letter. We got statements and videos from 16 of them. And I count at least 5 (and more likely 12) members who go down in flames as future leaders of the progressive movement if after all this they cave. But they’re not going to do it before the bill before them violates those standards: available nationwide, no triggers, no co-ops, no opt-outs.
I think those votes are well in excess of the votes they’ll need, because as I said a couple of months ago, once you start getting below 28 hard-core Democratic “no” votes you’re looking at members who think they’ll lose their seats if they vote “yes.” And that number is looking a lot closer to 40 these days.
But the “progressive block” was always just part of a larger and much more dynamic strategy, a firewall staked in the end zone at the beginning of the campaign (a perilous mix of metaphors, but I can’t think of a better way to say it). We’ve been working backwards from there, targeting Harry Reid and making it difficult for him to unload the public option without risking his own political future. And we’re not done, not by a long shot. We’ve been working diligently behind the scenes on things that nobody knows about yet, in anticipation of what is to come.
There are a lot of things that are going to happen between now and the conference report to shape the dynamics surrounding a vote. I wouldn’t make the mistake of thinking that what the situation looks like now is what it will look like then.