Pelosi's game runs deep
Even if Nancy Pelosi does get 218 votes for a public option with Medicare rates plus five percent, there's virtually no way any such bill gets signed into law. The Senate probably doesn't have the votes for a straight "level-playing field" trigger, much less one using Medicare rates. The White House will probably kill any such attempt themselves, as they don't want to face the combined fire of the doctors, hospitals, device manufacturers, pharmaceutical companies, and insurers, all of whom will flip out in response to the version of the public option that will cut their reimbursement rates.
This isn't a controversial take, of course. Pelosi wants the strongest possible public option in order to go into House-Senate negotiations with the strongest possible hand. In general, people have assumed that this is all about negotiating for the final public option. But it's not, really.
The part of Pelosi's approach that people haven't really picked up on is that she's paired the stronger public option with more generous subsidies and benefit packages, rather than leaving it on its own to dramatize the potential savings. There's a reason for that: If the Senate wants to weaken the public option, this gives her leverage to demand that they put money on the table to maintain the benefit levels that the strong public option made possible. In other words, the strong public option also gives her leverage to bargain for more affordability and better subsidies.
Photo credit: Brendan Hoffman/Bloomberg.
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