The death of the "public option": What's really going on?

By Michael J.W. Stickings

So. Is the "public option" dead or not? One of the Democrats on the Senate Finance Committee, Kent Conrad, says it is. (And I responded yesterday.) Health and Human Services Secretary Kathleen Sebelius says is it as well... or not. Therein lies some confusion, and she may very well herself be confused. She seemed to back it on This Week (ABC) yesterday, only to pull back on State of the Union (CNN). As she explains on the latter, the "public option" is "not the essential element" of reform.

Don't worry, it gets more confusing.

Sebelius was essentially just echoing the president himself, who on Saturday said this:

The public option, whether we have it or we don't have it, is not the entirety of health-care reform. This is just one sliver of it, one aspect of it, and by the way it's both the right and the left that had become so fixated on this, that they forget everything else.

Please. This is Obama, once more, playing to his beloved middle, and, in the process, vilifying both sides. This is hardly fair, though, to those on the left who voted for Obama, who continue to support Obama, and who support the "public option" because they believe, as I do, that only a government-run health-care coverage option will do what reform is supposed to do, which is not just keep costs down but provide access to coverage, and therewith to care itself, to all Americans, notably to the millions and millions who either lack coverage altogether or have no choice with respect to the coverage they have, squeezed by the profit-based insurers who are more likely to deny coverage than to extend it. To call this a fixation, as Obama does, is insulting.

Otherwise, of course the "public option" is not the entirety of reform. Of course there are other elements to it. It is simply a fact that reform is a comprehensive package. But to describe the "public option" as merely a sliver. Is that also not insulting? And is that not grossly misleading? To those who lack or have inadequate coverage, this is not a mere sliver but rather the essence of the thing. The same goes for those of us who support govermment-run health care -- and I, for one (as a Canadian who likes the Canadian system -- I am also British and feel the same way about the British system), support a single-payer government-run system that is far more extensive that what is currently being proposed in the U.S.

Sorry, Mr. President, but in playing to the middle, where conservative Democrats and a handful of Republicans, the latter clearly taking their marching orders from the right (and being as partisan as always), are trying to water the bill down so much as to render it inadequate, if not to defeat reform altogether, you risk losing the base, and bulk, of your support not just on "the left," as if only ideological extremists are supporting the "public option," but among the various liberals and progressives and moderates who want this to be meaningful reform and who think that now is the time, at long last, for just the sort of government involvement in health care that you here dismiss.

On CNN, Sebelius was pushing "consumer choice," "choice and competition," not the "public option" specifically or any specific version of reform. An administration official told Marc Ambinder that Sebelius "misspoke," on the "essential part" bit, while anther official, Linda Douglass (a key White House player on reform), said that Obama still supports a "public option." A third official refuted the first: Sebelius did not misspeak.

So what is it? As the Times is reporting:

The White House, facing increasing skepticism over President Obama's call for a public insurance plan to compete with the private sector, signaled Sunday that it was willing to compromise and would consider a proposal for a nonprofit health cooperative being developed in the Senate.

That seems to be the point White House Press Secretary was making on Face the Nation (CBS) yesterday. As Ambinder summarizes, "Gibbs said that fostering competition and choice were non-negotiable, but the specific mechanism designed to do so was up for discussion."

So Obama is waffling, Sebelius is waffling, Democrats in the Senate are waffling, and, meanwhile, Republicans are getting what they want, which is Democratic divisiveness and, ideally for them, inaction on reform altogether, all while they continue to score political points by lying about the Democratic plan.

But is Obama really pulling back from the "public option"? Perhaps not. He surely knows that he needs to reach out beyond his liberal-progressive base if reform is ever to be passed. While he may see non-profit co-ops as a suitable replacement for a government-run component, could it not be that his waffling, his apparent pull back, is actually part of his larger campaign to pass a comprehensive reform package that includes a "public option"? He has done this before, after all -- in a way, it is his modus operandi. He reaches out in search of compromise and bipartisanship, knowing that, ultimately, the other side won't agree to an acceptable compromise. But then he can at least say that he tried, that his motives were genuine, while ensuring that blame is directed at the other side. He seems to be doing with with Iran, so why not with the Republicans and the obstructionists in his own party?

But then there is the other possibility, that Obama knows that "Obamacare" is a tough sell that is unlikely to pass the Senate. Maybe he thinks that some reform is better than no reform, that a bill with non-profit co-ops is better than no bill at all, that, ultimately, the best that can be achieved is not the best (the "public option") but something that at least comes close to it.

Either way, Obama is being his usual realist self -- and it is realism that forms his core, so much not the idealistic rhetoric that we came to know during the campaign. I do not excuse him for calling the "public option" a sliver or for blatantly dismissing the concerns of "the left" as somehow akin to the fearmongering of the right, but, still, it is possible that he is doing everything he can to ensure that the best possible bill is passed.

Which is not to say that I won't be disappointed if reform does not include a "public option." I will be -- just as I am angry and frustrated now. To me, there is simply no excuse for failing to go all the way.