Watering down the public option

By Carrie Budoff Brown
|  Saturday, Oct 10, 2009  |  Updated 10:00 PM CDT
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Team Obama

AP

Senate Democrats are growing increasingly bold in predicting a public health insurance option will pass Congress this year, defying months of pessimism and outright opposition from party moderates.

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Senate Democrats are growing increasingly bold in predicting a public health insurance option will pass Congress this year, defying months of pessimism and outright opposition from party moderates.

But it’s not the “public option” you think.

Groping for a way out of a political bind, Democrats are defining down what constitutes a government-run insurance plan — and by extension, what it takes to declare victory.

At this point, Senate Democrats are signaling they could get behind just about anything they could plausibly call the public option – from a “trigger” that could kick in a public insurance plan later, to Delaware Sen. Tom Carper’s proposal to give states an option to create a government program.

Liberals who’ve long distrusted private insurers and dreamed of a nationwide, government-run insurance plan see it as a cave-in. Senate leaders see something different — a path to 60 votes for the first time all year.

“It’s a tried-and-true legislative strategy for getting everyone to ‘yes,’ ” said a Democratic strategist familiar with congressional leadership strategy. “Narrow your differences by broadening the definition of what constitutes success.”

The Democrats haven’t exactly been subtle in this move-the-goalposts effort.

Despite near-irrefutable evidence that Democrats lacked the votes for a pure public option, Sen. Chuck Schumer (D-N.Y.) has been saying with confidence, almost without equivocation, that his party will win the fight, predicting “some kind of public option” will make it into the final bill.

“I’m very optimistic,” Schumer said – at a time when there seemed little reason for optimism, with the Senate Finance Committee rejecting two public option amendments last month and President Barack Obama reluctant to describe it as a must-have.

This doctrine of maximum flexibility originated in the White House, as the president and his aides frustrated Democratic activists for months with their refusal to specify what exactly “public option” means. But it wasn’t until the last week or so, as alternatives to the traditional public option emerged, that more Senate Democrats began to acknowledge a new point of reference.

The rhetorical shift is important as Democrats move into a phase in which Obama and Senate Majority Leader Harry Reid (D-Nev.) take a more direct role in negotiating a compromise. But it also puts Democratic leaders on a collision course with the party’s liberal base, which turns apoplectic at the thought of settling for a state opt-in program.

“It doesn’t provide people through the country with the choice of a public option,” said Richard Kirsch, campaign manager of Health Care for America Now, which advocates for a government program. “A public health insurance option needs to be: national, public and available when health care reform is implemented and the Carper plan falls short of those very basic goals.”

Democrats don't need to reframe the public option in the House, where Speaker Nancy Pelosi (D-Calif.) is expected to have an easier time rounding up votes. She is considering several scenarios — including a government plan that would reimburse health-care providers at 5 percent above Medicare rates, or one with negotiated Medicare rates.

Much like in the Senate, House liberals feel like a trigger or a Carper-style state opt-in falls short of their goals. But Senate Democrats argue that Pelosi's more liberal public option ideas have only a slim chance in the Senate, so their compromise concepts could carry the day in the final House-Senate negotiations.

In the Senate, it was Reid who launched the reframing effort last month, when he described the public plan as “in the eye of the beholder.” Last week, he said it was a “relative term.”

Sen. Debbie Stabenow (D-Mich.) suggested everything from a “trigger” on a public option to a “robust” government plan modeled after Medicare could meet the test. “It is a broad definition,” she said last week. “There is a way to do this at the state level.”

And Senate Majority Whip Dick Durbin (D-Ill.) said he was “inclined positively” to view Democrats as fulfilling their promise of a public option if they deliver a bill to Obama with the Carper plan included.

One Senate Democratic aide said this view is “shared broadly” in the caucus.

The substantive shift is unmistakable.

For months, the public option meant one of two things: a national insurance plan that was a sort of Medicare-for-all, or one based on negotiated rates with doctors and hospitals. Moderates have balked at both versions, and by Schumer’s own count, Senate Democrats lacked the votes for either one.

Sen. Kent Conrad (D-N.D.) stepped forward with a proposal to establish nonprofit insurance cooperatives. But liberals sniffed at that idea as a feeble competitor to private insurance, and it, too, would fall short of 60 votes. Still, Reid embraced the concept in early September as potentially meeting the call for a public option.

In the last two weeks, Carper emerged as the newest dealmaker. He proposed giving states the option of creating a government plan or co-ops or expanding state employee insurance purchasing pools to all residents. Centrists, including tough-to-please Sen. Ben Nelson (D-Neb.), like it, but progressives look upon it warily.

Liberals are more inclined to support a successor to the opt-in: the opt-out. Working together, Carper and Schumer began talks with colleagues this week to allow states to opt out of a national insurance plan.

Aides caution that the discussions are early, and the ideas not yet fleshed out. They also say these are not the only compromises under consideration.

But the bottom line on all the above? Reid could argue each one is a “public option.”

The president indicated in a private call this week to Sen. Olympia Snowe (R-Maine) that her “trigger” proposal was still on his radar. He raised it in their conversation, Snowe said, telling her there would be opportunities to discuss the trigger down the road.

“But he obviously needs to work within his own party,” Snowe said, “so it is a long journey ahead of us on health care.”

Snowe has shown little interest in any proposals that create a government insurance plan at the outset of the reform. She wants to give private insurers a chance to become competitive before injecting a public option into the market.

Despite all their courting of Snowe, Democrats may not need her in the end.

Schumer has indicated that centrists are more open to the public option than they are against it, providing room to negotiate a compromise that works for all 60 Democrats.

Through it all, progressives are still holding out hope that Schumer and Reid will go for the kind of public option activists have envisioned for years.

"We know what a public option is, and in my mind what a public option is is a program that exists in 50 states in America," said Sen. Bernie Sanders (I-Vt.) "It is a Medicare-type program and my goal is to make sure as many people as possible will have the choice of that option. That is what a public option means to me."

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