The Public Option Trap

Progressives won a victory Oct. 26 when Senate Majority Leader Harry Reid announced that the health-care reform bill he will send to the Senate floor will include a government-run national health insurance plan — the “public option.”

Democratic leaders in the Senate and the White House had been dithering for months over whether the health reform bill should include a nonprofit “public option” to compete with the for-profit health insurance companies. Senate Finance Chairman Max Baucus (D-Mont.), with White House support, kept negotiating with Republicans through the summer in case weaker reforms might attract some moderate Republicans to sign onto the bill and give it the cover of bipartisanship. But as Republicans continued to balk, progressive activists worked to revive the reform movement, targeting Reid and wavering Democrats. Then President Obama’s Organizing for America supporters and allied organizations made a show of force on Oct. 20, placing 315,000 calls to Congressional offices to urge movement on the reform bill. Many callers also urged that the bill include a public option.

Finally, Reid realized that there were only a couple moderate Republicans left in the Senate and Sen. Olympia Snowe (R-Maine), the best hope for a GOP sign-on, just wasn’t that into health care reform.

Progressive Democratic senators also forced Reid’s hand when they said they would not support a bill that did not include a public option, said Sen. Dick Durbin (D-Ill.), who, as majority whip, is in charge of counting votes. If Reid had found a way to 60 votes without a public option, he would have gone there.

Reid is proposing a public option that apparently would be limited to individuals who are not covered by their employers. But it also sets a potential trap for “conservatives” as it lets states prohibit their residents from participating (the “opt-out” clause).

We would prefer a national insurance plan that lets small businesses and individuals buy into an expanded Medicare program (as Democrats are considering in the House). But a public option with the “opt-out” provision could put pressure on “conservative” candidates for governor and state legislatures to explain why their constituents should not have the same rights as residents of other states to choose an efficient government insurance plan instead of a bloated corporate insurance plan.

After all, a Medicare-style government insurance plan could earmark more than 95% of premiums for medical care and would have no incentive to deny coverage. Private, for-profit insurance plans can spend less than 70% of premiums — and as little as 60% — on medical care, with the rest going to administration, marketing and corporate profits. And corporate bureaucrats would still have an incentive to arbitrarily deny coverage to improve the corporate bottom line.

If people get a chance to buy into a government-run insurance plan, corporate insurance lobbyists fear that it would be too popular. Then any state legislature that decides to “opt out” — denying their citizen the opportunity to sign up for national government-sponsored health insurance — would give progressive populists a great pocketbook issue to organize working people.

In the 26 states that have statewide referenda processes, any “opt-outs” would be subject to public referendum campaigns aimed at reversing the opt-out. As Al Giordano wrote at NarcoNews.com (Oct. 27), “These would be a community organizer’s dream and an anti-public option politician’s nightmare. Even in those states without referendum processes, the public ire would be focused on those state legislators and governors that denied their own citizens access to what citizens in other states will have: a federal health insurance option to compete with those offered by the big insurance companies.”

All of a sudden, entrenched legislators would become electorally vulnerable to populist challengers who vow to return the stolen public health option to the people.

Progressives should work to make sure all 60 senators in the Democratic caucus stay in line for a strong health reform bill with at least some public option to keep the process moving.

Sen. Joe Lieberman (I-Conn.) put those prospects in doubt Oct. 27 when he proclaimed that he would support the Republican filibuster of health care reform as long as the Democratic bill contains a public option. But he left enough wiggle room to permit himself to be coaxed back into the fold after he basks in the glow of national attention.

Reid said he believed Lieberman “will let us get on the bill, and he’ll be involved in the amendment process,” but Reid should be ready to call his bluff and put Lieberman and other Democrats on the record on the direction of health reform. (Lieberman promised to support universal health coverage when he ran for re-election as an independent in 2006 after being defeated in the Democratic primary, but it wouldn’t be the first time he has double-crossed his colleagues.) The Senate also should go on the record as to whether working people and small businesses should have a choice between a corporate insurance plan and opting to buy into Medicare. Then Democratic voters will have an opportunity to determine whether their representatives and their senators have whored out their votes to the insurance companies. Republican Congress members, almost to a man and woman, undoubtedly have sold out to insurance companies.

Whatever emerges from the Senate will have to be settled with the House, where Democratic leaders are struggling to get the votes to pass their own robust public option that would allow small businesses and individuals to buy into an expanded Medicare program. That could replace the Senate public option.

Does your Congress member fear the insurance lobbyists more than he or she fears you? Give your rep and your senators a reason to fear you if they oppose a public option to compete with private insurance companies. Call them via the Congressional switchboard, 202-224-3121, and voice your support for a robust public option that anybody can buy into next year, not in 2013.

Progressive groups such as MoveOn are targeting conservative Democrats such as Blanche Lincoln (Ark.), Ben Nelson (Neb.) and Mary Landrieu (La.). MoveOn surveyed its 3.2 million members and found that 93% do not think the group should support senators who vote with Republicans to filibuster the health bill.

If Democrats can’t come up with 60 to beat a filibuster, they should pass the public option through the budget reconciliation process, which is not subject to a filibuster. And they should make the reforms effective next year instead of 2013. Republicans will squeal like stuck pigs, but working people will appreciate Dems looking after their interests by whatever means necessary.

Get Rid of the Filibuster

Democrats need to enforce party discipline on the filibuster, which unfortunately has been turned into a routine procedural motion by unscrupulous Republicans. The filibuster no longer is used sparingly to protect the rights of the minority on matters of principle. If members of the Democratic caucus will not support the caucus on procedural matters, such as siding with the GOP on filibusters, then they should lose leadership positions afforded by the caucus. (Lieberman, I’m looking at you.) If party leaders won’t enforce discipline, progressive Dems should run challengers against fair-weather Democratic senators.

We are stuck with unequal representation in the Senate, as small states wield disproportionate power under election rules dictated by the Constitution. Thomas Geoghegan has calculated that, in the Senate, 41 senators representing 10% of the population can block a bill favored by 59 senators representing 90% of the population. However, the filibuster comes under Senate rules, which can be changed at the start of any new Congress (or in mid-session, if the leadership is hard-nosed about it). The system is broken, Republicans are unabashed and the Democratic majority should do away with the filibuster, as the GOP threatened to do the last time they were in power. At least it should be refined to prevent partisan abuse. — JMC

From The Progressive Populist, November 15, 2009


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