Is the public option really necessary?

To public option or not to public option? That seems to be the most pressing question swirling around Washington's healthcare debate lately.  The public option, which would offer a government-run health insurance program (like Medicare), would be available to anyone. But in the past few days, the White House has received a great deal of criticism from liberals over its apparent willingness to move ahead with healthcare reform legislation that does not include a public option. (Today, there are indications that the Obama administration and Democrats may be ready to forge ahead on healthcare reform without Republican input -- which may bode well for a public option.) 

Is the public option necessary for real healthcare reform? The subject has sparked a real debate on the left, with a selection of the full spectrum of opinion, below:

PUBLIC OPTION HARDLINERS

Paul Krugman, New York Times: "Look, it is possible to have universal care without a public option; Switzerland does. But there are some good reasons for the prominence of the public option in our debate ... Add in the dealmaking as part of the health care process itself, and progressives can be forgiven for having the impression that Obama (a) takes them for granted (b) is way too easily rolled by the other side ... So progressives have their backs up over one provision in health care reform that’s easy to monitor. The public option has become not so much a symbol as a signal, a test of whether Obama is really the progressive activists thought they were backing ... And the bizarre thing is that the administration doesn’t seem to get that."

Chris Bowers, OpenLeft.com: "The goal isn't to have a President who agrees with the concept of a public option. Rather, the goal is to actually have a robust public option that is available to all Americans. Some people might be confusing these two ideas. Personally, I think this is because some people in progressive media are more interested in engaging the long running 'Obama is a progressive versus Obama hurting progressives' argument, rather than actually achieving legislative results. I don't know how large either group actually is, and even combined they are certainly not a majority of the progressive blogosphere community, but both groups are more interested in winning that argument than actually achieving legislative results."

Joan Walsh, Salon.com: "A few smart pro-Obama bloggers, most notably Ezra Klein and Nate Silver, have tried to make the case that losing the public option shouldn't lead Democrats to block the bill, but I'm not sure I can agree right now. Sure, it would be great to cover the uninsured and abolish discrimination based on pre-existing conditions, as well as get Obama a big legislative victory his first year in office. But I think a bill that lacks a mechanism to reduce health care/insurance costs, as the public option would -- the Congressional Budget office estimates it would save about $150 billion over the next ten years, or roughly $1,100 for every taxpayer, according to Silver – sets up the Democrats for political losses down the road."

Rachel Maddow, MSNBC: “We know that the president both when he was a candidate and well into the current debate as president said that a public option was a must. [Clip of Obama saying: ‘That’s why any plan I sign must include an insurance exchange, including a public option.’] ‘Must,’ he said — ‘must.’ He has changed his mind on that now apparently. … [W]hy is the public option dying now? It’s dying because of a collapse of political ambition. The Democrats are too scared of their own shadow to use the majority the American people elected them to in November to actually pass something they said they favored.”

Markos Moulitsas Zúñiga, aka Kos, DailyKos.com: "I wonder if the White House truly understands the depth of anger they'll face from the progressive side if they fail to pass health care reform with a strong public option. We haven't busted our asses the last four years to pass bank bailouts and give insurance companies everything they ever wanted. If we wanted that, we'd be Republicans."

Jon Stewart, The Daily Show: “Wait a second! What did you just say?! … No public option? … Did you just drop public option? … Mr. President, I CAN’T TELL IF YOU’RE A JEDI — 10 STEPS AHEAD OF EVERYTHING — OR IF THIS WHOLE HEALTH-CARE THING IS KICKIN’ YOUR ASS JUST A LITTLE BIT. Why is this so hard? Why can’t you guys just stay on message? Remember the Bush team? Little bit of discipline, little bit of repetition. They sold us a WAR nobody wanted and nobody needed. [Clips of President Bush, Secretary Powell, Condi Rice, Secretary Rumsfeld, Vice President Cheney, Mrs. Bush all echoing each others’ language in the run-up to Iraq.] Salesmanship! THOSE GUYS could sell ice cubes to Eskimos. The Democrats, I don’t even think could sell Eskimos BEEP they need — insulation, heating apparatus. … Yes, we can! [pause] Unless you don’t think we should!”

Bob Herbert, New York Times: "The hope of a government-run insurance option is all but gone. So there will be no effective alternative for consumers in the market for health coverage, which means no competitive pressure for private insurers to rein in premiums and other charges. (Forget about the nonprofit cooperatives. That’s like sending peewee footballers up against the Super Bowl champs.)"

Robert Reich, Salon.com: "I would have preferred a single-payer system like Medicare, but became convinced earlier this year that a public, Medicare-like optional plan was just about as much as was politically possible. Now the White House is stepping back even from the public option ... Without a public, Medicare-like option, healthcare reform is a bandaid for a system in critical condition. There's no way to push private insurers to become more efficient and provide better value to Americans without being forced to compete with a public option. And there's no way to get overall healthcare costs down without a public option that has the authority and scale to negotiate lower costs with pharmaceutical companies, doctors, hospitals, and other providers -- thereby opening the way for private insurers to do the same."

Eugene Robinson, Washington Post: "Barack Obama took office pledging to be a transformational president. The fate of a government-run public health insurance option will be an early test of his ability to end the way Washington's big-money, special-interest politics suffocates true reform ... Without that option, what Obama now calls "health insurance reform" still would be better than no reform at all. But frankly it's becoming hard to tell. So many genuine reforms have been taken off the table -- fully universal coverage, the ability to negotiate prices with the drug companies -- that expectations are ratcheted down almost daily ... Giving up on the public option might be expedient. But we didn't elect Obama to be an expedient president. We elected him to be a great one."

Noam Scheiber, The New Republic: "Around the conference table at TNR, we've been saying for weeks that what Obama really needed was a group of equally vocal, equally zealous critics on the left, pulling the debate's center of gravity in the other direction. And, wouldn't you know, that's exactly what's happened over the last 48 hours. We've now got a pole on the left to match the intensity of the pole on the right ... From a sheer tactical perspective, I think the White House and the Democratic leadership in Congress have dramatically improved their position ... Inside Congress, Obama may not get a public option, but if he doesn't, he was never going to get it. And now he can extract a ton of concessions in return, because he can point to a left-wing of his party that's ready to eat him alive for failing to deliver on it (whereas that left-wing outrage was largely hypothetical before now). That kind of leverage is extremely helpful."

Robert Creamer, HuffingtonPost.com: "Hasty headlines to the contrary, it is very likely that a strong public option will be part of a final health insurance reform bill when it finally passes Congress this fall ... A Public Option is the most elegant and politically viable solution to a major practical problem."

The New York Times: "For the sake of a health care deal, President Obama is hinting that he may be willing to drop the idea of a government-run insurance plan to compete with private insurers and hold down premium costs. He should not give up without first getting a strong alternative to achieve the same goals — and so far there is nothing very strong on the political horizon."

Matthew Yglesias, Think Progress: "One bill, a filibusterable non-reconciliation bill, would set up the basic framework of a health insurance “exchange” on which individuals and small businesses could get insurance. It would feature an employer mandate, some kind of sad co-op, and some not-very generous subsidies. It would be subject to various kinds of regulation including the White House’s key eight points of consumer protection. It’s a bill liberals would find horribly disappointing, but you could imagine it getting sixty votes in the senate ... Then if you get that done, all you need is a second bill. At that point, changing the co-op rules to make it work like a real public option, making the subsidies more generous, expanding Medicaid, and other wholesome progressive stuff all becomes budget-relevant material that can be done through reconciliation with only fifty votes. It’s not clear at this point that the public option has fifty votes in the senate, but it’s close, and I’m reasonably certain that the votes could be found if the procedural path existed.

Jonathan Cohn, The New Republic: "In an ideal world, the best approach would to be to admit that promising everybody the opportunity to keep their coverage, as Obama has done, is just not that advisable. A better promise would be that government won't force anybody to drop good coverage--that the relatively modest number of people switching insurance will be making a change for the better. There are signs that the House legislation is at least moving in that direction, since it seems to have a more porous firewall--and an apparent commitment to high subsidies."

PUBLIC OPTION GOOD -- BUT NOT NECESSARY

Nate Silver, fivethirtyeight.com: "From the President on downward, the White House now seems resigned to losing the fight over the 'public option', a government-run insurance plan that would complete against private plans. It's time to re-assess the playing field in light of this development ... Is the public option really dead? Probably ... Perhaps the better question is whether the public option was ever really 'alive', meaning that it ever had enough votes to pass both the House and the Senate. ... Why doesn't the public option have the votes for passage? You'd think that a provision that is both fairly popular and money-saving was a good bet for passage. But the insurance industry really, really does not like the public option. We'd previously estimated that its lobbying influence has cost the public option something like nine (9) votes in the Senate ... This is an unpleasant truth. But just because it's an unpleasant truth doesn't mean that it's not the truth ... Is a bill without a public option worth passing (if you're a Democrat)? From a near-term political standpoint, almost certainly yes. Bill Clinton suggested on Thursday that the President's approval rating would get a five-point boost the moment that health care legislation passed with his signature. I don't know if that's exactly right, but this is certainly a better scenario for Democrats than the world in which health care reform fails and they're getting blamed by pretty much everybody and have nothing much to run on in 2010.

Mike Lux, OpenLeft.com: "The folks who read my blog posts might be surprised to learn that there is an alternative to the public option I could live with (besides single-payer, of course, that being my preferred option from the beginning). I have been an advocate for a very hard line on the public option, as I discussed here yesterday. But there is one other alternative I would feel okay about ... So to my esteemed colleagues in the insurance industry, how's this for a compromise: we'll give up the public option but we will regulate health insurance rates instead. We will institute a system of strict price and rate controls, just like utilities have to live with where they weren't deregulated. That would do more to cut health care cost increases than any other thing we could do. So what do you think, guys?"

Ezra Klein, Washington Post: "This strategy, of course, relies on a lot of trust, and that's not something the White House has these days. But that's the administration's argument: Phase one is not a negotiation, and you can't demand a perfect product out of both chambers. In this period, the White House will do whatever is necessary to clear a bill out of the Senate, and if that means bargaining away the public option, so be it. Phase two is a negotiation, and you should trust the White House to produce a good piece of legislation. And phase three, well, that's the easy part. That's passage. Hopefully."