Robert Pear and Sheryl Gay Stolberg provide a fairly balanced assessment of White House leadership on health reform in their Sunday New York Times overview, “Obama Strategy on Health Care Legislation Appears to Be Paying Off.”
As the authors report, the bills have advanced “further than many lawmakers expected” and “five separate measures have been pared down to two” — the farthest advance of major health reform legislation to date. They quote senior White House advisers saying the bills’ advancement “vindicated Mr. Obama’s strategy of leaving the details up to lawmakers.”
Stolberg and Pear describe the White House strategy as calibrated to encourage momentum above spending a lot of time trying to win on specific policy disagreements:

White House officials approached their work like a political campaign, and they said they had learned as much from the 2008 presidential race as from the health care fiasco of 1993-94. They said they learned the importance of pressing on and keeping up momentum, even when cable television commentators — and some fellow Democrats — declared their initiatives dead.
Congressional Democrats said it often seemed as if the top priority for the White House was simply to advance health care bills to the next step in the legislative process…Indeed, that is exactly what White House officials were trying to do. They described their legislative strategy as a very step-by-step process, in which they kept intensely focused on the next specific goal: passing a bill out of this or that committee, resolving the doubts of particular lawmakers, like the liberals who met with Mr. Obama on Thursday.

The article quotes White House Chief of Staff Rahm Emanuel describing the President’s strategy as giving “leeway to legislators to legislate,” but “not leeway to take a policy off track.” But he cautions against overconfidence, adding “you don’t see any shimmying in the end zone…No spiking the ball on the 20-yard line here.”
Pear and Stolberg touch on the critique of the President’s strategy:

The legislative progress has come at a price. In the absence of specific guidance from the White House, it has moved ahead in fits and starts. From here on, the challenges will only grow more difficult…In the Senate, where Democrats will need support from every member of their caucus to reach a critical 60-vote threshold to avoid a potential filibuster, Mr. Obama’s hands-off strategy carries particular risks. ..Without clear direction from the president on the public option, the Democratic leader, Senator Harry Reid of Nevada, moved ahead last week on his own, unveiling a bill that includes a government-run plan, but allows states to opt out.
Even close allies of the White House sometimes questioned its approach…“It felt like it was getting out of control at the end of July and in the beginning of August,” said John D. Podesta, a former chief of staff to President Bill Clinton who informally advises the Obama White House. “People were getting nervous that it was going every which way.” Mr. Podesta said the president risked “giving too much rope to a Congress that is liked a lot less than he is.”

The White House has received a lot of criticism for giving verbal support for the public option, but not fighting for it, Indeed the Administration made a point of saying the public option was not essential. It appears that Team Obama decided that joining in the public option debate more energetically might have endangered the reform package by prolonging debate and attracting more attacks from the right. Instead they will support the Democratic consensus that will be worked out between the House and Senate distillations. Keep it moving forward.
They may be right. If Democrats can keep losses in next year’s mid-term elections to a reasonable minimum, it is possible that economic recovery will kick in more vigorously, placing Obama and the Democrats in good position for ’12. With even modest gains in ’12, they can pass an amendment providing a stronger public option. OK, that’s three big “ifs,” but not an implausible scenario.
Polls indicate a solid majority of the American people want a public option of some kind. For example, an NBC News/Wall Street Journal Poll conducted by the polling organizations of Peter Hart (D) and Bill McInturff (R). Oct. 22-25, 2009, indicated that 72 percent agreed that it was “quite important” (27 percent) or “extremely important” (45 percent) to “give people a choice of both a public plan administered by the federal government and a private plan for their health insurance.”
But Obama and Reid can add, and they don’t yet have 60 votes to support a strong public option, although Open Left‘s Chris Bowers believes a ‘robust’ public option, including “the original vision of a public option, tied to Medicare rates, that is available to everyone in America” is still a possibility.
It appears some of the DINOs and moderate Republicans are bucking the will of their constituencies. That’s where the progressive fight should be going forward: to hold those Senators accountable in their states for dissing their constituents to curry favor with the health insurance industry. Sens. Joe Lieberman (CT), Ben Nelson (NE), Blanche Lincoln (AR), Olympia Snowe (ME) and Susan Collins (ME) should be hammered with reminders that a lot of voters in their respective states want a public option.
A Daily Kos poll, conducted 9/8-10, found that 55 percent of Arkansas respondents supported a public option. Another Daily Kos poll, conducted back on August 17-19, asked Nebraskans “If Ben Nelson joined Republican Senators in filibustering and killing a final health care bill because it had a public health insurance option would that make you more or less likely to vote for him or would it have no real effect on your vote?,” 21 percent said “more likely” with 15 percent chosing “less likely” and 64 percent selecting “no effect.” Not much of an advantage either way there.
Sen. Joe Lieberman’s Connecticut constituency supports the public option by 64-31, according to a Quinnipiac University poll, conducted 9/10-14. Regarding the two Maine Republicans, a poll by Democracy Corps, conducted 9/23-27, found,

…Mainers overwhelmingly support a government sponsored non-profit health insurance option, 63 to 27 percent. And they support this option from the start significantly more strongly than they support a “trigger” (52 to 34 percent) that would create the government sponsored non-profit health insurance option only if private health insurance companies do not make affordable coverage available within several years.

Alternatively, if Reid is unable to cobble together 60 votes for allowing a majority vote on a bill with a public option, Dems could go the ‘budget reconciliation’ route, with 51 votes needed to get one. In that event, there will be even more weeping an gnashing of teeth among conservatives about the lack of bipartisanship, a theme they will try to make into a prevailing meme. Dems can challenge it by emphasizing majority rule — not super majority rule — is the moral standard of democracy and the public option is consistently supported by a majority of Americans.
Despite the assertion of Stolberg and Pear, Obama and Reid can both credibly argue that they have made a sincere effort to recruit Republicans to support the public option voters want, and media coverage has been adequate to back them up. But the GOP has become an ossified, hard-line political party that places a higher value on obstructing change than bringing it about. That’s not a tough sell.
Democratic leaders should fight like hell to get 60 votes to allow a vote on the public option. There’s no getting around the fact that support of 60 percent of the Senate would add credibility to health reform. But if we don’t get it, then anything over 51 votes through budget reconciliation is an acceptable — and defensible — alternative.

Jonathan Wesiman’s “Democrats’ Quiet Changes Pile Up” in The Wall St. Journal takes an insightful look at some of the more impressive ‘below the radar’ progressive reforms President Obama has secured so far, with the support of the Democratic majorities in Congress. Weisman explains:

Last week, Mr. Obama signed defense-policy legislation that included an unrelated measure widening federal hate-crimes laws to cover sexual orientation and gender identification — 12 years after it was first introduced. The same legislation also tightened the rules of admissible evidence for military commissions, an issue that consumed Congress in debate in 2007 but received almost no attention this go-round.
Other new measures signed into law since the administration took office, all of which kicked up controversy in past congresses, make it easier for women to sue for equal pay, set aside land in the West from development, give the government the power to regulate tobacco and raise tobacco taxes to expand health insurance for children. Congress and the White House, in the new defense-policy bill, also killed weapons programs that have survived earlier attempts at termination, among them, the F-22 fighter jet, the VH-71 presidential helicopter and the Army’s Future Combat System.

Not a bad tally for less than 9 months on the job, particularly in comparison the limited positive accomplishments of the previous train-wreck that careened through the White House for 8 years. it’s not hard to imagine conservative defenders of tobacco, insurance and timber companies, along with military contractors, fuming at these achievements. Give the Obama Administration credit for astute management of its broader legislative agenda and outflanking the GOP obstructionist machine. As conservative Republican Tom Price of Georgia is quoted as saying in the article, “The administration is pushing so many things so rapidly it’s difficult to concentrate on all of them.”
Add to these victories President Obama’s appointments and unraveling with executive orders, where possible, the Bush Administration’s institutionalization of incompetence and greed in government. No more Bush family friends and cronies running federal agencies charged with life or death decisions that affect millions — that alone is a quiet, but huge change for the better. The positive changes initiated by President Obama will continue to grow and benefit millions down the road. In terms of tangible reforms, his critics will have a very tough time comparing him unfavorably to post-war Republican presidents — and we’re only 8+ months into this presidency.

Please, all moderate, centrist and conservative Democrats, take a few minutes to read Paul Krugman’s op-ed. “The Defining Moment ” in The New York Times, and then take a few more minutes for honest self-reflection. History is calling, and there may not be another chance to do so much to help so many people, whose very lives are at stake for a long long time. As Krugman explains:

…Everyone in the political class — by which I mean politicians, people in the news media, and so on, basically whoever is in a position to influence the final stage of this legislative marathon — now has to make a choice. The seemingly impossible dream of fundamental health reform is just a few steps away from becoming reality, and each player has to decide whether he or she is going to help it across the finish line or stand in its way.
…The people who really have to make up their minds, then, are those in between, the self-proclaimed centrists….Senator Joseph Lieberman of Connecticut says, “I want to be able to vote for a health bill, but my top concern is the deficit.” That would be a serious objection to the proposals currently on the table if they would, in fact, increase the deficit. But they wouldn’t, at least according to the Congressional Budget Office, which estimates that the House bill, in particular, would actually reduce the deficit by $100 billion over the next decade.
…I won’t try to psychoanalyze the “naysayers,”…I’d just urge them to take a good hard look in the mirror. If they really want to align themselves with the hard-line conservatives, if they just want to kill health reform, so be it. But they shouldn’t hide behind claims that they really, truly would support health care reform if only it were better designed.
For this is the moment of truth. The political environment is as favorable for reform as it’s likely to get. The legislation on the table isn’t perfect, but it’s as good as anyone could reasonably have expected. History is about to be made — and everyone has to decide which side they’re on.

Health care reform legislation, because of its complexity, will never be perfect for anyone. But nothing will pass if moderates insist on having their way about every single aspect of health reform. Legislation to improve on the consensus bill can be passed later on, when problems become evident. It’s a work in progress. History is calling. Who will answer the call?

In her article, “Disorganized: What Happened to Obama’s Massive Network of Grassroots Activists?” at The New Republic, Lydia DePillis reveals one of the key reasons for the post-election floundering of the activist coalition that was instrumental in electing America’s first African American President. In a nut graph, Depillis explains:

…The biggest problem was built into OFA’s very structure–the structure that Plouffe had wanted and Hildebrand had warned against. Obama’s people had created something both entirely new and entirely old: an Internet version of the top-down political machines built by Richard Daley in Chicago or Boss Tweed in New York. The difference (other than technology) was that this new machine would rely on ideological loyalty, not patronage. And that was a big difference. The old machines survived as top-down organizations because they gave people on the bottom something tangible in return for their participation. By contrast, successful organizations built mainly on shared philosophy tend to be driven by their memberships. Marshall Ganz, the legendary United Farm Workers organizer-turned-Harvard-professor and godfather of the Obama field strategy–he helped orchestrate Camp Obama, a grassroots training program for staff and volunteers–sees the command-and-control nature of OFA as a crucial flaw. “It’s much more an instrument of mobilizing the bottom to serve the top than organizing the bottom to participate in shaping the direction of the top,” he told me.

DePillis adds “…Being part of the DNC has neutered Organizing for America when it comes to pressuring moderate Democrats.” With regard to the battle for health care reform in particular, she cites the examples of ‘outside groups,’ including the Progressive Change Campaign Committee, MoveOn, and Health Care for America Now, which are “running hard-hitting ads that target foot-dragging congressmen,” while OFA’s ads “were gauzy and positive, mentioning no one by name.” As DePillis explains, “The White House couldn’t deal with Max Baucus in good faith if its ground operation was hammering him in Montana.”
DePillis is undoubtedly correct that there are built-in limitations that come with OFA operating as a DNC entity, particularly with an issue that has many complex facets, like health care reform. Activist networks work best with a simple idea, such as electing a particular candidate, or legislation that does one major thing. Perhaps the best test for OFA’s effectiveness will come when all of the Democratic reforms are reconciled into a single bill.
Multi-faceted legislation like the current health care reform packages being proposed, are more likely to experience fragmentation of activist energy. It’s easier to mobilize citizen lobbying around a simple idea, like no disqualifying coverage for prior conditions, than it is to get activists excited about a complex package that includes numerous provisions. It doesn’t mean that big package strategy for health care reform is wrong; It may be the right way to go at this political moment. But it’s reasonable to expect some dilution of grass-roots energy as the complexity of a reform increases.

I’ll just share three interesting revelations scattered among the fallout from Senate Majority Leader Harry Reid’s announcement yesterday of the compromise Senate health reform package.
First, in his op-ed in today’s WaPo, “Health Reform’s Chevy Tax,” Harold Meyerson sheds fresh light on the numbers involved in the tax on the so-called ‘Cadillac benefits”:

The Senate’s tax would initially apply to all individual policies costing more than $8,000 a year, or $21,000 for a family. Those thresholds are to be indexed to the overall consumer price index (CPI) plus 1 percent. Problem is, medical costs and health insurance premiums increase a good deal more than the overall CPI. Since 2000, they have risen three to four times faster — which means, more policies will be subject to the tax with each passing year. The congressional Joint Committee on Taxation has calculated that in 2013, when the reforms kick in, the tax will apply to 19 percent of individual plans and 14 percent of family plans, but that by 2019 it will sock 34 percent of individual plans and 31 percent of family plans.
Last time I looked, a third of American motorists were not driving Cadillacs…Unfortunately, that excise tax targets a lot of Chevy plans as well.

Meyerson adds that the assumption that workers will get higher wages to help pay for the taxes is not warranted by recent experience, and he supports the surtax on incomes over $500,000 funding proposal championed by House Speaker Nancy Pelosi and others as a more credible progressive alternative.
I do hope Andrew Sullivan is right in his ‘The Daily Dish’ post “The Lethal Politics Of The Opt-Out Public Option” in The Atlantic Online. Sullivan writes:

…Imagine for a moment that the opt-out public option passes and becomes law (I give it a 65 percent chance at this point). Then what happens? Well, there has to be a debate in every state in which Republicans, where they hold a majority or the governorship, will presumably decide to deny their own voters the option to get a cheaper health insurance plan. When others in other states can get such a plan, will there not be pressure on the GOP to help their own base? Won’t Bill O’Reilly’s gaffe – when he said what he believed rather than what Roger Ailes wants him to say – be salient? Won’t many people – many Republican voters – actually ask: why can’t I have what they’re having?
This is why this is lethal. The argument against new entitlements requires a macro-level perspective. You have to argue that…you just need to rely on the wonderful private sector to deliver the goods in a more market-friendly way. This is always a tough sell because it requires voters to put abstract concerns over practical short-term gains. It’s why conservatism always has a tough time in welfare state democracies…Imagine Republicans in state legislatures having to argue and posture against an affordable health insurance plan for the folks, as O’Reilly calls them, while evil liberals provide it elsewhere…I can see a public option becoming the equivalent of Medicare in the public psyche if it works as it should. Try running against Medicare…it has the potential to make “liberalism’ popular again; it has easily demonized opponents – the health insurance industry; and it forces Republicans not to rail against socialism in the abstract but to oppose actual benefits for the working poor in reality.

If Sullivan is right, the opt-out concession to win moderates could end up being more of a problem for Republicans than an unadulterated ‘robust’ public option.
Lastly, anyone seeking a convincing explanation for Sen. Lieberman’s opposition to the public option for health care reform, despite strong support for it in recent polls, need not look much further than Charles Lemos’s MyDD post “The Worries of Joe Lieberman ,” in which he explains:

“I want to be able to vote for a health bill, but my top concern is the deficit.” So says Senator Joe Lieberman of Connecticut, a state that is home to 72 insurance headquarters, the largest concentration of that industry in the nation. Connecticut has three times the US average of insurance jobs as a percent of total state employment. In 2004, the insurance industry in Connecticut was a $12.2 billion dollar industry. Two years later, it hit $14.6 billion. That’s a CAGR of 9.4 percent.
Sixteen of those 72 insurance companies provide health or medical service insurance. Those 16 insurance companies employ over 22,000 employees and have annual payroll of over $2.3 billion. The total annual state insurance industry payroll exceeds $6 billion. 5.5 percent of the state’s gross domestic product comes from the insurance industry. But no Joe Lieberman isn’t worried about their profits, he’s worried about adding to the deficit.

Lemos goes on to add that Lieberman’s crocky tears about the deficit are somewhat belied by his blank check support for war ops in Afghanistan, now over $230 billion over the last 8 years, coupled with the fact that the CBO projects more than $100 billion in savings as a result of the publlic option over the next 10 years. As Lemos puts it “I can see a return on investment in healthcare, it’s harder to see one on Afghanistan.”

Pronin2 of Daily Kos discusses Rachel Maddow’s excellent interview of Senator Ron Wyden (D-OR) (clip included in post), in which Wyden and Maddow add a sobering note to the overheated debate about the public option — that, according to CBO analysis, it would only be available to about 10 percent of the workforce under Reid’s compromise. Wyden argues that 10 percent is really not a large enough portion of consumers to hold down health care premiums, and it could be even smalller with the states’ opt-out. Says Wyden:

The bottom line is that the public option can’t really hold private insurers accountable if it is only competing for 10 percent of the insurance market, because private insurance companies aren’t going to change their business practices if 90 percent of their customers can’t take their business elsewhere.

He also says that the opinion polls showing a healthy majority in favor of the public option would likely be very different if they said something like “Would you support a public option open to a small number of people, not all?”
Wyden will be introducing an amendment to make the public option available to all consumers. Senator Jeff Merkley, also of Oregon, will introduce an amendment to broaden public option converage to include employees of small businesses.
Looking at it from another angle, it really is amazing that in the 21st century as many as 40 U.S. Senators, including even Olympia Snowe, would prefer to see tens of millions of Americans have no health security whatsoever, rather than support a public option — that’s a choice, not a requirement — for just 10 percent of consumers. It’s a sad measure of the moral decline of the Republican Party from the days when at least a few reasonable conservatives walked among them.

Senate Majority Leader Harry Reid has announced the broad outlines of the Senate’s health care reform compromise bill, which includes a public option with no ‘trigger mechanism,’ but which does have an “opt-out” provision for the states. The compromise reflects Reid’s math that his chances for 60 votes are better if he doesn’t try to win the support of Senator Olympia Snowe, whose “trigger mechanism” would have lost the vote of WV Democrat Jay Rockefeller and perhaps others. According to The New York Times report,

Senator Olympia J. Snowe of Maine…issued a statement saying that she would not support for Mr. Reid’s plan. “I am deeply disappointed with the majority leaders’ decision to include a public option as the focus of the legislation,” she said. Ms. Snowe expressed her long-standing position that a government-run plan should only be “triggered” in states where the health care legislation otherwise fails to provide affordable insurance to enough people.

It’s likely that Snowe’s inflexibility contributed to Reid’s decision — that if he announced in favor of a “trigger mechanism,” she would hang tough for a standard that would make any possibility of a real public option very doubtful, according to many experts. it appears unlikely that she would have been open to a face-saving “hair trigger’ version in which the ‘public option’ would kick in quickly, if insurers fail to offer affordable coverage. In the end, Reid must have concluded that she was more interested in killing the public option, period, than in achieving a compromise that would be acceptable to most Democrats. No doubt Reid also felt a responsibility to voters, who opinion polls indicate favor a real public option by a healthy margin. Making Snowe happy would likely have cost Democrats — and Reid — considerable public support. It appears she overplayed her hand.
According to the L.A. Times report by Noam M. Levey, Reid’s plan has 58 votes, and he feels that he has a good chance to win the two more he needs for victory on a cloture vote. Levey did not identify the two Senators Reid needs to win, But the NYT article says that Senators Mary Landrieu of Louisiana and Ben Nelson of Nebraska have “expressed doubts” about the plan.
The plan reportedly also provides for taxing of the so-called “Cadillac” health care plans, although there are no details about definitions yet available. Hopefully Reid won’t draw the line low enough to incur the opposition of unions. Democratic support for Reid’s compromise will turn to some extent on the Congressional Budget Office cost analysis.

Admirers of Rep Alan Grayson have a post to read at The Nation, where John Nichols reports on the congressman’s new project:

The Florida Democrat who drew national attention last month when he declared on the House floor that the Republican plan for uninsured Americans was “don’t get sick, and if you do get sick, die quickly,” was back on the House floor this week to announce the creation of a website to honor the victims of the current system.
Grayson, who has taken the lead in highlighting a Harvard study that shows 44,000 Americans die annually because they have no health insurance, told the House and the nation: “I think it dishonors all those Americans who have lost their lives because they had no health coverage, by ignoring them, by not paying attention to them, and by doing nothing to change the situation that led them to lose their live.”
With that in mind, he announced the launch of a Names of the Dead website.

Nichols quotes from Rep. Grayson’s welcoming message at his website:

Every year, more than 44,000 Americans die simply because have no health insurance…I have created this project in their memory. I hope that honoring them will help us end this senseless loss of American lives. If you have lost a loved one, please share the story of that loved one with us. Help us ensure that their legacy is a more just America, where every life that can be saved will be saved.

Naturally, the Republicans are going ballistic about Grayson’s latest project. But it’s a wonderful idea and a highly creative use of the internet to promote awareness of the brutality of the current ‘system’ and the urgent need for comprehensive, affordable health care reform. Rep. Grayson is providing either a courageous template for Democrats running in moderate to conservative districts or a cautionary example of political harakiri. Either way, in my book, he merits consideration for the JFK Library’s Profile in Courage Award (make your nomination here).

A just-out WaPo-ABC News poll reveals that the ‘public option’ for health care reform now wins a “clear majority” (57 percent) of the public, according to a report in today’s Post by Dan Balz and Jon Cohen. However, the poll also brings signs of trouble for the proposal to tax the so-called ‘Cadillac’ health care benefits, as Chen and Balz report:

But if there is clear majority support for the public option and the mandate, there is broad opposition to one of the major mechanisms proposed to pay for the bill. The Senate Finance Committee suggested taxing the most costly private insurance plans to help offset the costs of extending coverage to millions more people. Sixty-one percent oppose the idea, while 35 percent favor it.

If Democratic lawmakers needed another reason to be skeptical about taxing health care benefits, unions are fiercely opposed to the idea. As Jeff Crosby put it in his AFL-CIO blog:

Vincent Panvani of the Sheet Metal Workers (SMWIA) warns:If any of these Democratic Senators vote for this, they’ll be out in 2010, and it will be used against Obama….[Y]ou’re taxing the middle class. Teamsters President James Hoffa calls taxing health care benefits “the poison pill that will kill reform.” The Laborers have attack ads at the ready…We have to say, right now, that we will kill any effort to tax our benefits as yet another transfer from our pockets to the health care profiteers.

Perhaps there is a income line that can be drawn to protect union workers from having their hard-won health benefits being taxed, while making those at higher income levels pay their fair share. Democratic leaders need to be very clear and unified that union benefits be exempted and only the wealthy, if anyone, will have their health benefits taxed. This ought to be doable, and most of the revenue shortfall should be made up with tax hikes on unhealthy substances like tobacco, liquor and soft drinks.

The moral case for the public option in health care reform has been well-made by numerous Democratic leaders, activists and writers, and some have also made a persuasive case that it’s good political strategy. Robert Parry’s Consortium News post, via Alternet, takes the argument a step further; that the public option is not only politically-wise; it should be implemented on a faster track — or the Democrats could be risking “electoral disaster.” As Parry explains:

Indeed, if the Democrats abandon the public option for the sake of passing a bill like the one that came out of the Senate Finance Committee, they may be courting electoral disaster once voters grasp that they will have to wait years for the law to be implemented and then that it could lead to higher costs for much the same unpopular private insurance plans.
…As the legislation stands now, many of the key features that hold some promise of helping consumers – such as the “exchange” where individuals and small business would shop for the best product – won’t even take effect until 2013. That means that Americans now facing the crisis of no health insurance won’t get much help for another four years, if then.
…By contrast to the four-year phase-in for these relatively modest reforms, the Medicare single-payer program for senior citizens was signed into law by President Lyndon Johnson on July 30, 1965, and was up and running less than a year later.
..The implementing delays mean that in both 2010 and 2012, Republicans will be free to make the truthful case that the Democrats – despite their promises – had accomplished little to help the American people on health care. Already, Republican senators are using the talking point that the four-year delay is part of a budgetary trick to make the bill appear cheaper over 10 years than it would be if its key features took effect quickly.

Parry believes the implementation delays of both the insurance exchanges and public option ‘trigger’ could work against each other to an even more deleterious effect:

…But the insurance exchanges won’t open until 2013, so it may take years before any trigger would be pulled. At minimum, the industry would have earned a lengthy reprieve.
And by the time, the exchanges have a chance to be tested, Congress and the White House could be in Republican hands. If that’s the case, the Republicans might well undo even the triggered public option. Unlike the Democrats, the Republicans would surely not worry about ramming their preferred policy through the Congress.

Conversely, Parry sees a huge upside to a bolder implementation strategy:

On the other hand, if Congress enacts a public option now, it presumably could be implemented at least as fast as Medicare, especially if it were piggybacked onto the existing Medicare bureaucracy. That would enable Democrats to show they had accomplished something beneficial for the public before voters go to the polls in November 2010.
By 2012, if the CBO predictions of substantial savings prove true, Obama could campaign for reelection on the basis that he had improved the welfare of the American people — and the budget outlooks for government and business.

It would be bitterly ironic if Democrats enacted a strong health care reform bill, with a solid public option, but then suffered political damage because it was implemented too late to do us some good. Parry makes a compelling case that putting implementation of both a public option and health exchanges on a faster track is wise strategy.