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The nightmare scenario on the public option

Imagine Reid puts Schumer's pulibc option proposal -- the national plan that states can opt-out of -- into the bill. The bill comes to the floor, and it loses Snowe and one or two centrist moderates. Byrd is sick and unable to vote. The sticking point is the Schumer plan, so it needs to come out of the bill.

But even though the bill can't get 60 votes to proceed, Reid's office also can't find 60 votes to strip the public option out of the bill. The liberals won't go for it. The left is organized against it. There's no reason, they say, that 55 Democrats should bow to the wishes of five centrists and a Republican on a popular provision. Reid and the White House should stop dithering and put their back into this, they argue. Indeed, maybe some mischievous Republicans even join the liberals in defeating the motion to strip Schumer's proposal. The bill is just stuck in limbo: It doesn't have the votes to move forward or backward.

There are reasons to think this isn't likely. Namely, it probably requires Republicans to engage in the sort of shenanigans that would persuade Democrats to vote as a bloc. If the Republicans play it straight and deliver 40 votes against the public option, you probably can find 20 or so Democrats willing to suck it up and water down the bill in order to ensure it eventual passage. Hell, 10 of those Democrats would do it happily.

But this is something people on the Hill are worrying about. And it's an example of how weird the math is getting now, and how many things can potentially go wrong.

By Ezra Klein  |  October 23, 2009; 3:42 PM ET
Categories:  Health Reform  
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No different than backroom deal making in French Bourgeois Court of Sun King!

Sausage making at it's peak!

Roll on, roll on Democracy roll on...

Posted by: umesh409 | October 23, 2009 4:08 PM | Report abuse

Wait a minute! If that happens, can't Reid just pull back the final bill and re-combine the Finance and HELP bills into a new final bill?

Posted by: tomveiltomveil | October 23, 2009 4:12 PM | Report abuse

... and if not, can't Reid just take the lack of cloture literally, lock the doors, and keep an open debate until someone snaps and votes for cloture?

Posted by: tomveiltomveil | October 23, 2009 4:14 PM | Report abuse

Why not just pass something similar to the House bill with a trigger then replace it with a strong public option in reconciliation?

Posted by: redwards95 | October 23, 2009 4:31 PM | Report abuse

Ezra, you're just preparing excuses for failure. Go take a walk and settle down. Don't worry, Congress will sell out fer sher.

Posted by: Dollared | October 23, 2009 4:33 PM | Report abuse

THIS is the nightmare scenario for the public option: We came close to having a robust PO in the House. Then hours before, the President lets it be known he prefers Snowe's trigger, and suddenly scores of previously whipped House Democrats are undecided again. What a loser!

Posted by: bmull | October 23, 2009 4:48 PM | Report abuse

bmull, I was wondering: what is Obama thinking. Here's a take from CNN:

CNN: "In recent days, two administration officials have told CNN that the prevailing White House opinion is for the Senate health care bill to include a so-called 'trigger' mechanism proposed by Snowe that would bring a public option in the future if thresholds for expanding coverage and lowering costs go unmet in coming years. The source familiar with Thursday evening's meeting said Obama 'pushed for a so-called trigger, because it's the more bipartisan way to go,' due to Snowe's support for the concept" (Bash and Walsh, 10/22)."

So, this suggests Obama has a certain confidence in the effect of having a trigger. Perhaps the idea that insurers will innovate or something to avoid a trigger, for instance.

There is a certain kind of quality, of real value, in avoiding some battles though... I'm thinking of that Eastern kind of thing. I vaugely recall an example from one novel, which I'll slightly modify:

If the bird won't sing, then what do you do?

General A: Kill the bird.

General B: Make the bird sing.

General Tao: Wait.

(Of course, only the third strategy results in birdsong.)

Posted by: HalHorvath | October 23, 2009 5:04 PM | Report abuse

If that happens, can't he combine the PO w/the education bill and do that through reconciliation and then do the exchange and market reforms w/60 votes?

Or just keep it on the floor and force the debate; I really don't think that conservatives will have the stomach to keep filibustering health care reform.

Posted by: Rhoda | October 23, 2009 5:15 PM | Report abuse

Olympia Snowe has now stands alone, and as such, she will not have the strength to stand against White House bullying. It's inconceivable that she can refuse to do what Rahm Emanuel tells her to do.

Posted by: truck1 | October 23, 2009 5:29 PM | Report abuse

"isn't likely.... probably .... If ... probably ..."


Posted by: ostap666 | October 23, 2009 5:32 PM | Report abuse

@Hal: One can wait around and hope for the bird to sing, but meanwhile Congress might actually pass a bill which increases premiums, combined with an individual mandate and a tax on employer benefits. Better to tell the bird to get lost, and elect a new bird in 2012.

Posted by: bmull | October 23, 2009 5:47 PM | Report abuse

Those who think Sen. Snowe cannot withstand White House pressure are wrong. She can very well oppose the final bill without any compunction. She has absolutely nothing to lose. Even if her state is Blue and it wants PO, in the end political reality is such that her vote on the final bill does not seem to have any impact on her political credibility or electability.

She is in unique position. Question is why more did not join her.

Finally, this whole obsession with Public Option is so much of a Liberal shtick; but with much lesser importance in the end.

What matters is 'bending the curve with budgetary discipline’ even though those phrases are so discredited and maligned. To assume 'costs can be reduced' with PO or anything in the air; does not seem to be correct. Or to think brow beating Insurance Industry with Market Cap of just $60B with annual profits not more than $10B in total (margin 5% or around) will solve the problem.

We just have to look at a chart Ezra produced on this blog. It is an exceptionally revealing chart where he showed premium growth for various existing options in different states. All of them failed to nail the cost (assuming premiums by and large faithfully represented underlying costs).

So even after all this 'Ramayan and Mahabharat' (marathon / herculean) efforts; there is no certainty whether American Political Process / law making sausage has produced something to depend upon.

This means legal arrangements to have 'iron clad' mechanisms built into the law to control costs are very important and more importantly, a room for experimentation, 'walking back and forth as needed'; all of that is needed.

All this noise about PO - not convinced what core value it adds.

Posted by: umesh409 | October 23, 2009 8:34 PM | Report abuse

Room for "walking back and forth." Would that there were such considerations. Not with this crowd. You are entirely wrong in thinking Olympia Snowe can withstand the pressures of Emanuel and Axelrod. Everyone has ways in which he can be bribed or threatened, and she must, too. She is like the zebra who has isolated himself from the safety of the pack. She will be devoured by the predators. Watch and see. Zero chance she will vote against anything proposed the White House wants. She has gone too far along with them. She is now on their ground. I believe her career is finished with this move.

Posted by: truck1 | October 23, 2009 9:27 PM | Report abuse


oh come on now. Why bend the cost curve when you can "stick it" to insurers. I love the whole don't tick us off or we'll end the anti-trust exemption. Those politicians have NO IDEA what they're talking about and how much they'll hurt their constituents if they did that and forced federal regulations of insurance. Every state has different needs when it comes to healthcare. What's needed in Mississippi is NOT what's needed in Alaska. What's important to California is not likely important to Rhode Island. Sure some things are universal like maternity care, mental health parity, but many many other mandates are not. I'm thinking Nevada would like gambling addiction covered under healthcare but does Alaska need that??? NJ and NY cover infertility treatment. Does Alabama want to PAY for that for all its citizens??

Posted by: visionbrkr | October 23, 2009 10:37 PM | Report abuse

I've been noticing the difference lately between comments that you used to get from the American Prospect and those you get now. IN the "olden" days, the comments were well informed, pretty educated guesses or estimates, and always added something to the discussion. Now that's you are the WaPo, the comments tend to be more ideological. On the other hand, you get pushback which is probably good for you intellectually! Make you think about your assumptions more carefully? This particular post is pretty speculative and doesn't really have as much backup as you usually provide.

Posted by: LindaB1 | October 24, 2009 1:18 AM | Report abuse

LindaB1: I sense your distaste for idealogues, but I have an equal distaste for the beltway arrogance that often settles into these forums.

Let's not forget there are real lives at stake in this debate. Here in California, for instance, the median family income is about $80-90K--too high to qualify for subsidies under ANY of the proposals being discussed. DOL says our living expenses are $70K on average, but that statistic belies huge variability due to locale and family structure. Most families are perpetually on the brink of insolvency.

Now along come the beard-pullers who decide that "we're all going to have universal health insurance." The main practical effect of this is going to be a new $10,000+ (there's no cap) mandate to buy a faulty insurance product people mostly got by without.

Again this is a fairly average uninsured family. There are millions of people in California who fit this scenario. They do want quality affordable health care. But I assure you they do NOT want the kind of
"help" the White House and its health industry cronies are currently envisioning.

Posted by: bmull | October 24, 2009 7:24 AM | Report abuse

Speaking of "beltway" tunnel-vision, consider how Senator Ben Nelson is on the verge of taking Nebraska's choice *away from Nebraska* by a lack of logical thinking...

"Reid still has some work to do. Sen. Ben Nelson (D-Neb.) has continued to express skepticism about the state opt-out, preferring instead to allow states to choose their own competitor to private insurance." -- Politico

So...Nelson would vote so that Nebraska won't have the choice to opt-out and "choose their own competitor"...!!?

eh....these Senators need our help in logical thinking, people.


Posted by: HalHorvath | October 24, 2009 11:54 AM | Report abuse

Guys, we already have 4 “public options”. Medicare, the public option for seniors passed in 1965, is on track to bankrupt the country by 2017, as the 78 million baby boomers become eligible for and begin to use it in large numbers. Bill Clinton already has had his heart attack and open heart surgery and he was barely 60. 78 million senior citizens all expecting the miracles of modern medicine, including but not necessarily limited to stem cell infusions are on the way. Look out! There aren’t enough doctors or nurses or hospital beds or medical miracles to handle that load.
Then we have Medicaid and SCHIP, which most doctors won’t accept because the reimbursement rate is too low to cover their “overhead” let alone buy them a new Lexus every year. The VA system is so overwhelmed by returning veterans suffering from PTSD, burns and amputations that older veterans with diabetes and heart disease can’t get in anymore. You want to go to the doctor at the Wadsworth VA in West Los Angeles? The line starts on Ventura Blvd in the San Fernando Valley.
Health insurance in America is too expensive for the same reason that flood insurance is too expensive in New Orleans and hurricane insurance is too expensive in South Florida and the Bahamas. Try buying earthquake insurance in California if your house sits on the San Andreas Fault. If we all took as poor care of our cars as we do our bodies, who could afford auto insurance…Donald Trump? Bill Gates? T. Boone Pickens? Covering “pre-existing” medical conditions is a non-starter. Could you buy a new homeowners policy from State Farm if your kitchen was already in flames and the fire engines on the way? Duh! Could your family buy a new insurance policy on your life if you were already dead?
I have been a doctor for 50 years. I preach healthy living and eating at I do walk the talk. That's why I made it to age 75 while most of my male relatives didn't. That is the only way to solve the healthcare crisis.

Posted by: doc4 | October 24, 2009 4:07 PM | Report abuse

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