How Long Can the Health Care Liberals Hold Out?

About that threat by dozens of members of the Congressional Progressive Caucus to vote against any health care legislation that doesn’t include a “robust” public option, two things can be safely said: No one in the White House or the Democratic congressional leadership is surprised by it, and everyone expects that that the progressives will fold in the end.

House Speaker Nancy Pelosi expressed this attitude fairly well when, at a press conference two weeks ago, she responded to the notion of liberal defections this way: “Are you asking me, ‘Are the progressives going to take down universal, quality, affordable health care for all Americans?’ I don’t think so.”

Back then, the progressives were rebelling against a Pelosi-backed compromise with conservative House Democrats that watered down the public option—rejecting the liberal demand that Medicare rates be used to set health care provider reimbursements. That was enough to convince 57 progressives to sign a letter to Ms. Pelosi stating that “we can not support such a proposal.”

Now, all of a sudden, it appears that even the watered-down public option—which is also included in a plan passed by the Senate Committee on Health, Education, Labor and Pensions (H.E.L.P.)—isn’t long for this world. The Obama administration emphatically distanced itself from the concept over the weekend, something the Senate’s Democratic leaders had already done last week.

In its place, Mr. Obama and the Senate’s leaders seem prepared to support non-profit insurance cooperatives, an idea championed by a bipartisan group of six senators who sit on the Senate Finance Committee—which also has jurisdiction over health care legislation and which has yet to reveal its final plan.

From here, it’s clear how the game is supposed to work: When Congress returns in September, the Finance Committee will pass a bill with co-ops, which will then be reconciled with the H.E.L.P. bill, resulting in a final Senate bill that doesn’t include a public option.

Meanwhile, the House will pass the compromise that Mrs. Pelosi negotiated a few weeks ago—the one with a watered-down public option—but that public option will then be sacrificed when House and Senate conferees hash out a joint package.

Then, with a final, public option-less bill in hand, the White House and Mrs. Pelosi’s team will plead with, cajole, and—if necessary—threaten just enough progressives into holding their noses and voting for it, asking them the whole time if they really want to be responsible for killing the first serious health care overhaul in decades (and maybe the Obama presidency, too!).

Obviously, this doesn’t seem fair. After all, the conservative House Blue Dogs held out a few weeks ago, threatening to derail health care if their demands weren’t met. But instead of writing them off, Mrs. Pelosi cut a deal with them. Why won’t the progressives be treated the same way?

The easiest answer is that they are victims of their own loyalty to the Democratic Party. Already this year, 11 of the 52 House Blue Dogs voted against the stimulus package; 14 of them voted against the budget; and 29 rejected the climate change bill. In short, the Blue Dogs have established that they’re willing to walk away from the Democratic caucus.

Not so for the progressives. With 79 voting House members, they are the largest Democratic sub-group, but they have a reputation on the Hill as a loose collection of idealistic pushovers—true believers who can always be won over with the “this is the best deal we could get” argument.

The assumption is that nothing will change on health care. Sure, the progressives want a real public option. But what are they going to do? Side with the Republicans and up with nothing at all?

On the afternoon of Aug. 17, Representative Raul Grijalva of Arizona, the co-chairman of the Progressive Caucus, issued a statement reaffirming that a majority of his members “will oppose any health care reform legislation that does not include a robust public option.  Our position has not, and will not, change.”

Democrats now have 256 votes in the House, and there’s little reason to believe that, even with the public option gone, they’ll attract any G.O.P. support for health care legislation. That would mean that a simple majority of Mr. Grijalva’s C.P.C. colleagues could prevent a bill without a public option from passing.

The final vote is still a few months away. How long can Mr. Grijalva and his allies hold the line?   

How Long Can the Health Care Liberals Hold Out?