Chuck Schumer, who stands to be a very big political winner if a public option is included in the compromise health care bill that will soon come to the Senate floor, offered a very specific assessment of where the public option debate in the Senate now stands on Sunday’s “Meet the Press.”
“I think we’re very close to getting the 60 votes we need to move forward,” he said, “and my guess is that the public option level playing field with the state opt-out will be in the bill.”
Obviously, those words mean absolutely nothing to the vast majority of Americans, who routinely tell pollsters that they’re confused beyond hope by the health care debate in Congress.
But if you take apart Schumer’s 35-word sentence and translate it into English one layer at a time, it’s actually one of the more significant public statements on where this process may be heading.
Start with the term “public option level playing field with the state opt-out.” You’ll never see it on any bumper stickers, but it actually represents a painstaking and slightly ingenious compromise on the most politically sensitive issue involved in the reform push.
The basic contours of the public option debate are easy to discern: liberals generally want one, and conservatives don’t. But that only gets you so far. There are numerous variations on the public option concept.
At its most basic, academic level a public option would give all Americans the option of purchasing their insurance from a government-run provider. The program, with its low overhead costs and the potentially massive number of enrollees, would be in position to severely reduce health care costs, both for its own customers (by using its size to bargain for deep discounts) and for customers of private insurers (which would be forced to innovate in order to compete with the government program).
But this pure form of a public option, which would fundamentally alter the health care landscape overnight (and run more than a few private insurers out of business), is too radical for Congress. So from the start, the bills introduced in Congress have aimed to restrict the number of people who would be allowed to participate in the public option: basically, no one who is eligible to receive insurance through his or her employee could participate under any version. Only about 15 million Americans would actually have the option.
But that alone wasn’t enough to unite the Democrats behind the public option concept. Conservatives Democrats, from the beginning of the debate, wanted further restrictions on the government’s involvement.
This is where Schumer and the “level playing field” portion of his “Meet the Press” comment come in. Back in early May, he responded to conservative Democrats’ fears by proposing that, essentially, any public plan be subject to the same rules and conditions that private plans face-no taxpayer support, no subsidies, and no linking reimbursement rates for providers to Medicare (a favorite idea on the left, since Medicare’s rate are so low).
This “level playing field” adjustment achieved some of its intended effect-but not all of it, something that was vividly illustrated when the Senate Finance Committee (chock full of conservative Democrats) took up the public option on September 29.
Five Democrats that day joined with all of the committee’s Republicans to vote down a non-level-playing field public option (i.e. one in which reimbursement rates would be pegged to Medicare) proposed by West Virginia’s Jay Rockefeller. Schumer’s level playing field option, when it was voted on, won over two of the Democrats who’ opposed Rockefeller’s plan. It wasn’t enough to force a public option into the Finance Committee’s bill, but it showed that Schumer’s plan was more palatable to conservative Democrats.
In an effort to win over the rest of his Democratic colleagues, Schumer then began promoting the “state opt-out” idea-basically, enacting a level playing field public option while giving states the right to ban it from their exchanges.
The pragmatic appeal of this was obvious: Holdout red state Democrats like Kent Conrad, a Democrat from North Dakota (where one powerful insurance company enjoys a monopoly-and won’t be happy with any politician who takes it away), might be able to justify voting for a public plan if they could tell their own constituents (and, perhaps more importantly, their patrons) that they’d never have to worry about it in their backyard.
This succeeded in moving the ball down the field further: Enough conservative Democrats expressed openness to the idea (without a corresponding number of liberals revolting) for Majority Leader Harry Reid to float a trial balloon late last week about including it in the final Senate bill.
The political reality of such a move became clear instantly, as Republican Olympia Snowe-who voted for the public option-less bill that cleared the Finance Committee-said she would join a Republican filibuster even against an opt-out plan. That meant that Senate Democrats, if they went ahead with it, would need all 60 of their members to vote to kill the G.O.P. filibuster. Just one defection would stop the bill.
Which is why Schumer’s prediction on Sunday that the opt-out version will make it into the bill is so significant. When you consider who the final holdout Democrats in the Senate are, it’s amazing to think that all of them might actually be talked into voting against a public option filibuster-the defeat of which would basically ensure the passage of a public option.
A prime example is Ben Nelson, a conservative from Nebraska and a former insurance executive who has been among the Democrats’ harshest public option critics this year. Nelson has nothing to gain personally or politically by doing anything to help the public option. Democrats could threaten and attack him all they want; their abuse only helps Nelson with his state’s conservative electorate.
But on Sunday, at around the same time Schumer was on “Meet,” Nelson was on CNN expressing qualified support for something very close to the opt-out-an “opt-in” plan.
The difference between the two is actually significant: The opt-out model would begin with the assumption that all 50 states are participating in the public plan; they would have to take steps to remove themselves, and it’s likely that only a handful of small, Republican-friendly states would. The opt-in model, meanwhile, would start with no states participating. Some would join quickly, but many would get bogged down in long, divisive fights while trying to join. A public option created under the opt-in concept would probably end up attracting far fewer participants.
Still, the fact that Nelson now seems to be this close-opt-out vs. opt-in-to joining his colleagues in stopping a filibuster seems to buttress Schumer’s optimism. If he and just a few other holdouts can be won over, a relatively strong public option will be in the final Senate bill-and will probably end up reaching President Obama’s desk.
If that happens, the old legislation-as-sausage-making metaphor will be affirmed: The process was ugly, protracted and (to just about every American) totally incoherent. But it may still produce something that isn’t all that bad.