Posted by: Jeff | August 17, 2009

Krugman Is Right, But Maddow May Do More Good

I’m of several minds about the public option question.

On the one hand, there is brute reality: the public option may not be political feasible, and it really isn’t essential to the push for health care reform. Rachel Maddow’s claim on Meet the Press that reform minus the public option “doesn’t change health care very much” and “won’t do very much for the American people” simply isn’t true. It’s actually a rather stupid thing to say. Even if the public option goes down, the legislation that ultimately comes out of Congress will include major new regulations to prevent rescission and denial of coverage by the insurance industry, new ways to bring comparative effectiveness research to bear on cost-cutting, new subsidies to help those who cannot currently afford coverage, a universal mandate requiring everyone to purchase coverage and, most likely, a system of health insurance co-ops or exchanges that will accomplish at least some of the competition and cost-saving pressure the public option was intended for.* Those are all changes which would be massive improvements over the status quo.

A public option would be wonderful, but it is hardly essential. As Paul Krugman points out in his most recent op-ed, other developed nations have created humane and functional universal health care systems without relying on insurance supplied directly by the government. Howard Dean might now be claiming that we can’t do health care reform without a public option, but the reform legislation he himself proposed during his presidential campaign in 2004 didn’t include one. What was he doing then, just spinning his wheels? Hardly. His plan was a good one, and would have been worth doing. Things have changed since 2004, and now we have even better plans on the table, and they’re worth doing too. Reform is an incremental process, not some glorious, one-time, all-or-nothing push. You can’t take further steps without taking initial steps, and we won’t be able to get wins down the road if we don’t get a win now. And need I remind everyone that liberals haven’t had a win on health care in decades?

On the other hand, a public option would be wonderful. And while its political feasibility is currently in doubt, the inevitability of its demise is certainly not set in stone. Robert Reich’s post argues that the votes are there to pass health care reform with a public option even if none of the Republicans in Congress are on board, and it looks like he’s correct. If so, that’s exactly what the Obama Administration and the Democrats in Congress should do.

In the past, the Administration has shown a weird attachment to bipartisanship simply for the sake of bipartisanship, but it won’t provide much political cover in this instance. One way or another, the Democrats are going to own health care reform politically. The GOP base is rabidly opposed to the whole business, as are the House Republicans. No one is going to be fooled if the Administration is able to peel off a few Republican supporters in the Senate. Such a meager claim to bipartisanship is not worth sacrificing the public option. And that’s where the likes of Rachel Maddow come in.

If we do manage to pull a public option out of this fight – if Obama and the Democrats lower their heads, square up their shoulders, and drive it on through despite the opposition – it will largely be because they were responding to the anger of progressives and Obama’s liberal base. A base represented in the public discourse by people like Maddow, Reich, Dean and all those myriad activist organizations.

The paradox is this: Pointing out that the public option is not a necessity, that we can live without it, even if true, makes the public option that much easier to abandon when the chips are down. Meanwhile, insisting that the public option is crucial, and that Obama and the Democrats would be betraying their supporters by not pushing for it full-bore, makes the successful creation of a public option more likely. In other words, saying the honest, reasonable and nuanced thing may very well create a suboptimal outcome in comparison to saying the simplistic, distorting and bull-headed thing. Welcome to politics.

*How much the co-ops or exchanges would accomplish is open to question. Reich may be correct that meaningful cost reform – and thus long term financial health – cannot be achieved without the public option.

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