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The Democratic Strategist

Political Strategy for a Permanent Democratic Majority

The Public Option and Its Passionate Defenders

If you’re wondering why the so-called “public option” in proposed health reform plans is such a line-in-the-sand non-negotiable requirement for so many progressives, you should definitely read Mark Schmitt’s brief item for The American Prospect explaining the history of this concept.
It all started, Schmitt explains, among single-payer advocates who had been convinced by pollster Celinda Lake that their approach just didn’t have enough popular support to carry the day:

One key player was Roger Hickey of the Campaign for America’s Future. Hickey took UC Berkley health care expert Jacob Hacker’s idea for “a new public insurance pool modeled after Medicare” and went around to the community of single-payer advocates, making the case that this limited “public option” was the best they could hope for. Ideally, it would someday magically turn into single-payer. And then Hickey went to all the presidential candidates, acknowledging that politically, they couldn’t support single-payer, but that the “public option” would attract a real progressive constituency.

John Edwards signed on, and then Obama and Clinton, and a hybrid proposal that added the public option to the prevailing concept of a competitive system of private insurance plans became the standard Democratic approach.
But baked into the cake was a subtle but important difference in perspective between single-payer fans who viewed the public option as the sine qua non, and other progressives who viewed it as just one of many moving parts in a comprehensive system.
That division continues today. Here’s how Schmitt describes the passion of single-payer advocates for a “robust” public option, as many House Democrats call their demand:

So now this energetic, well-funded group of progressives is fired up to defend something fairly complex and not necessarily essential to health reform. (Or, put another way, there are plenty of bad versions of a public plan.) The symbolic intensity is hard for others to understand. But the intensity is understandable if you recognize that this is what they gave up single-payer for, so they want to win at least that much.

So hard-line defense of the public option is about substance, but it’s also about emotion, and about people who think they’ve already compromised enough by accepting a system built around private health insurance. This is all worth remembering when the final deals get cut in Congress on health reform.

2 comments on “The Public Option and Its Passionate Defenders

  1. Tenacious D. on

    I agree with Bernie. Part of the reason Obama has ended up with an intra-party fight over a public option is due to the fact he didn’t mobilize any intensity around anything else. I’m no health care policy wonk, and I’m not wed to any particular policy mechanism–just to outcomes. But, I can sense when vigorous reform is in play, and I’ve had no sense of it in recent weeks. No one on the left was selling me any outcome worth fighting for, so I was forced to fall back in support of the public option bubbling back up from the grass roots. At least it was something that someone cared about! When Reich notified us that Obama had promised not to press pharma on prices, most of us who are politically active assumed he was knuckling under to special interests and we’d better do something quick. A robust public option was the only piece of policy driftwood available for us to grab on short notice. Obama’s coolness can be read as nonchalance.

  2. Bernie Latham on

    Thanks for that bit of history which I had not known.
    I’d argue that there is also another significant element in the mix for many of us supporting a robust public option. As Paul Krugman suggested in a recent column (or blog?) it will not prove a happy outcome if the tactics being utilized presently to kill reform and damage the President are seen to be successful. The public option has become a strong symbol of the contest between things as they have been and the hope for an era of progressive resurgence.
    The power of such symbols (and the power of the victor/loser dichotomy) seem well appreciated on the right.
    Obviously, we put ourselves at some risk merely in defining a concrete goal, the attainment of which is uncertain, and in acknowledging that if we aren’t successful in achieving it, then that will constitute a loss of significance.
    But I suspect that is the functional reality here.


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