The Public Option Is Dead, Long Live the Public Option

Illustration for article titled The Public Option Is Dead, Long Live the Public Option

A government-administered health insurance plan—similar to Medicare, for any American who wants it—has had a rocky debut on the national political stage this year. Known to its supporters and detractors alike as “the public option,” it was debated anew by the Senate Finance Committee Tuesday.


As befits such a heated debate, there were charts, there were bills waved, and strong words from both political parties. Bill Clinton era Labor Secretary Robert Reich, writing in the Huffington Post, laid out the political terrain:

Big Pharma and big insurance hate the public insurance option even more than they hate big Medicare discounts. And although the President has sounded as if he would welcome it, political operatives in the White House have quietly reassured the industries that it won't be included in the final bill. At most, the bill would allow the formation of non-profit "cooperatives" that wouldn't have the scale or authority to squeeze the profits of private industry, or a "trigger" that would allow states to form public insurance options eventually if certain goals for cost savings and coverage weren't met.

Nevertheless, in the public mind, the public option is still afloat—73 percent of physicians support the added competition, and 65 percent of the American people are now in favor. “If it’s 65 percent in America, I’m willing to bet it’s a majority in every state,” said Schumer, who with Sen. Jay Rockefeller (D-WV) reintroduced the amendment that had been thought dead just a few weeks ago.“So what’s the holdup?”

“People are really afraid of the public option,” responded Sen. Jon Ensign (R-NV). “Leading us to more and more government-dominated health care in the United States.”

Ensign was dead wrong. And that “slippery socialist slope” argument, while it once intimidated the White House, appeared to have lost credibility. White House Domestic Policy Adviser Melody Barnes, writing at AOL Black Voices, emphasized why the public option is important, for black America in particular:

If you don't have insurance – and one in five African Americans don't – the President's plan will provide you affordable options the same way Members of Congress get them: by creating an exchange where you can leverage the purchasing power of a large group to get reasonable prices and choose the option that's best for you and your family. If you still can't afford coverage, we will provide you a tax credit to help.

The President also believes that one of the choices in this exchange should be a public option. This option would be exactly what it sounds like – one more choice for Americans without insurance. [emphasis mine]


But this White House press offensive was clearly too little too late—the very definition was still subject to a fierce, often comic, semantic battle in the Senate. Rockefeller tried calling it a “consumer choice plan,” while Michigan Democrat Debbie Stabenow named it a “grand compromise.” Sen. Robert Menendez (D-NJ) flipped the phrase to explain it as “an option for the public.”

Sen. Kent Conrad (D-ND), who opposes the public option, tried to split the difference, using the example of nations like France, Japan and Australia who rely on not for profit insurers with impressive results. “We’ve gotten locked in a really stale debate that says your only alternatives are what we’ve got now or the public option,” he said, suggesting a middle road: Co-ops. Schumer forcefully stressed the need for competition in “the coagulated, ossified and fundamentally uncompetitive insurance market,” saying that “nothing will do it better” than the public option.


In the end, the Shumer amendment was defeated, 10-13, on a vote that split along party lines—with three Democrats administering the death blow: Conrad, Sen. Max Baucus of Montana, and Blanche Lincoln of Arkansas. It’s worth noting that these three senators represent 4,464,311 Americans combined—about 40 percent of the folks Schumer and Rockefeller represent. And, of course, a sliver of the 195 million Americans reflected in that 65 percent approval number.

No matter what the final name on the final health care bill, this was a defeat for America's supposedly advanced democracy. The Democrats in support of the measure envisioned an “independently financed, self-sustaining” insurance option that “will simply serve as one more choice” for Americans, said Menendez. “The most important thing is that consumers will not have to choose this if they don’t wish to.”


Today, however, it was a few small-state senators that had all the choice.


Covers the White House and Washington for The Root. Follow her on Twitter.