The White House’s game on health care reform has been obvious since at least the middle of the summer, when President Obama unnerved much of his base by announcing that “the public option, whether we have it or we don’t have it, is not the entirety of health care reform.”
That was news to much of the left, for whom the public option represents the only redeeming feature of the current reform effort. Without it, liberals suspect, reform will mostly amount to a massive, taxpayer-funded giveaway to private insurers, who—thanks to a new individual mandate—will be handed millions of new customers (many of them young and healthy) while facing no competitive pressure to cut costs or curb many of their unsavory, profit-minded practices.
In his public statements since then, including his September address to Congress, the president has made it clear he shares the left’s basic belief in the concept of a public health insurance option. But he has made it equally clear that his bottom line is different from theirs and that if a bill without a public option lands on his desk, he’ll still sign it.
Even now, with the left hoping that the White House will lean on Senate leaders—who are now trying to hash out a compromise plan from a Health, Education, Labor and Pensions Committee bill that includes a public option and a Finance Committee bill that doesn’t—to write a public option into the final bill, that bottom line isn’t budging, one of Obama’s top advisers made clear on Sunday.
In an appearance on ABC’s “This Week,” David Axelrod reeled off the usual platitudes about the public option and its potential to stir badly needed competition in the healthcare system. “But that doesn’t mean we halt the process,” Axelrod quickly cautioned. “There are people in the Senate, Republicans and Democrats, who have objected to [the public option], and we have to work through these issues, and we’re going to do that.”
He added: “There will be compromise, there will legislation, and it will achieve our goals—helping people who have insurance get more security, get more accountability from the insurance industry, helping people who don’t have insurance get insurance they can afford, and lowering the overall cost of the system.”
And when host George Stephanopoulos followed that up by asking if it was accurate to say that the White House wouldn’t demand a public option in the final bill, Axelrod replied, “I think the final bill will achieve those goals and a public option would help.” Which was a very long way of saying yes.
At one level, the White House’s posture makes sense.
They are guided—haunted, some would say—by Bill Clinton’s experiences when he threw himself into health care reform in his first term. Clinton and his wife commissioned their own task force, drew up their own plan, and attempted to impose it on Congress. They were met with resistance that should have been predictable and that should have triggered them to seek compromise. Instead, they dug their heels in, rejected deal-making from moderates, and watched the entire enterprise blow up in their faces.
Obama and his team have strived to avoid Clinton’s mistakes. That has meant showing extraordinary deference to Congress—setting a few broad, overarching goals for reform, then leaving it to House and Senate leaders to create a package that can actually pass both chambers and reach the president’s desk. Staying out of the public option debate, a very sensitive subject in the Senate, is part of this strategy.
There’s also a more basic imperative for the president: He badly needs to be seen as having scored a political victory on health care, an issue that has flummoxed and undermined presidents for decades. The promise of his presidency was and remains transformational change, but his critics—with increasing support from mainstream outlets—are starting to score points with the claim that he really hasn’t done much. A health care signing ceremony would serve as a powerful refutation of this contention.
Understandably, then, the White House view seems to be that some kind of reform bill, even if it ends up watered down and laughably limited in scope, is better than no reform bill—so why let a sticky subject like the public option be the deal-breaker?
Reinforcing this sense is the fact that the public option, even in the context of the most generous and expansive legislation now under consideration, would only affect a sliver of Americans—mainly small business employees and individuals not covered by employer plans. The vast majority of Americans would be ineligible to buy in even if they wanted to. The White House seems to have concluded that there’s no good reason to go to war over something that affects so few.
This sort of thinking isn’t wrong, politically. Any kind of health care reform bill this year probably will help the Democrats in 2010. But there is a longer-term consideration: If the bill is too weak and too worthless this year, it will be a lot tougher to go back and reform it and to make it more effective in future years.
This is the strongest argument for insisting on a public option, no matter how weak, right now: as long as a basic, skeletal outline of a public plan is in the final package, there will be something to work with in the future. There will be a chance, in other words, to create—eventually—a public option that will actually be open to all Americans and that will change the competitive landscape in the way proponents imagine.
That kind of reform will benefit Democrats far more in the long term –five, ten, 20 years down the line, much the way Medicare remains a political winner for them today.
If there’s no public option in this year’s bill, that future is hard to imagine.