A moment of choosing is fast approaching for Barack Obama and his party’s Congressional leaders: to sacrifice the public option that the Democratic base holds so dear, or to stick with it, damn the consequences.
Their decision looms as the difference between (almost) sure-thing passage of a compromise health care plan and an ugly, protracted legislative fight that could end up sinking all hopes of meaningful health care reform and severely wounding Obama.
But if that makes the choice sound easy, it’s not.
The creation of a government-run health insurance alternative for Americans is, to many of Obama’s most ardent supporters, in Congress and outside of it, the whole point of passing health care reform. In the more liberal (and filibuster-free) House, support for it is particularly strong. There’s the usual grumbling from the chamber’s centrist Blue Dogs, but Speaker Nancy Pelosi should ultimately be able to corral 218 votes for a bill with a public plan.
The Senate is where things get messy. Thirty-nine of the chamber’s 40 Republicans have gone on record opposing the public option, with the 40th—Maine’s Olympia Snowe—strongly hinting she’ll join them. That leaves Democrats with absolutely no margin for error if they hope to kill a G.O.P. filibuster and pass legislation with a public option. This was evident on Wednesday, when the Senate’s Health, Education, Labor and Pensions Committee backed public option legislation on a 13-10 party-line vote.
In theory, Democrats have the 60 votes they need to beat back a filibuster. But one defection would sink them, and there are almost too many potential defectors to keep track of—Mary Landrieu, Ben Nelson, Joe Lieberman, and Evan Bayh are just the most obvious candidates. The combined weight of the White House, party establishment, and liberal interest groups might not be enough to keep them in line. Nelson, for instance, might figure that bucking such pressure would play very well in red-state Nebraska.
This is where the compromise option comes into play. Max Baucus, the chairman of the Senate Finance Committee, has been working to craft a bipartisan alternative within his committee, and on Thursday afternoon he proclaimed that a deal was near. The precise parameters are unclear, but any compromise capable of winning Republican support won’t include a public option; the “non-profit cooperatives” that Baucus and Kent Conrad have championed will likely take there place.
This might—might—be good enough to win over a small number of Republicans, Snowe and Iowa’s Charles Grassley chief among them. In turn, this would make it far easier to keep the aforementioned centrist Democrats in line. Passage in the Senate would then become a near-certainty (maybe even by the August deadline Obama has set) and Obama would be in position to take credit for at significant overhaul of the health care system.
There are a couple of problems with this, though. First, dropping the public option could incite a rebellion among liberals in the House, which would still have to reconcile its legislation with the Senate’s. Would House conferees sign off on a plan with no public option? And would liberals in the House vote for it?
Moreover, it would devastate the Democratic base, which would view the removal of the public option for legislative expediency as an act of betrayal. The left is hardly fooled by Baucus and Conrad’s “non-profit cooperative” alternative: a “compromise designed to deal with problems in the Senate. But it doesn’t deal with problems in America,” is how Howard Dean has described it.
But the real risk is this: It probably won’t work. With or without a public option, any health care bill that Obama signs is going to come with a hefty price tag—which Republicans will relentlessly play up as further proof that the president is spending recklessly and imperiling the nation with debt. In fact, they’re already doing this. This is the real reason why, even without the public option, Obama will find very few Republican “yes” votes: the G.O.P. believes it can produce a repeat of 1994, when unblinking opposition to Bill Clinton’s health care plan helped spawn a midterm election rout.
So if Obama is going to sign a health care plan passed over almost universal Republican objections, the new system had better work. Otherwise, it will seal the G.O.P.’s argument—all that money wasted, and for such a terrible result! But the massive expense of reform won’t bother voters nearly as much if they believe it produced a positive result. With a viable public option, voters will have no trouble understanding that the system has been fundamentally changed. But without one?
This is why the White House has sent such consistently mixed messages on health care, hinting one day that a public option compromise would be acceptable, and the next that a public option should be passed even if no Republicans will support it.
There’s no clearly expedient path. To go all-in on the public option would risk death by filibuster (which then might prompt Senate Democrats to use the filibuster-bypassing “reconciliation” process, which would come with enormous political headaches); to deal it away would infuriate the Democratic base, possibly foment an intraparty uprising in the House, and make it tougher to sell the finished product to the public.
The last president was fond of calling himself “the decider.” Now, it’s Obama’s turn to play that role.