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Shoud the White House have been firmer on the public option?


A Talking Points Memo reader has an excellent observation on the politics of the public option and the anger of the left:

I think people are pissed right now less at the fact that they didn't get what they wanted, and more at the fact that they feel like their people didn't really fight for it. Leaders don't always get what they want. But people recognize when true leaders at least give it a shot. And people judge that leadership by what they say in public and how hard they see them publicly pushing for it. Closed door negotiations don't count.

They wanted to see Obama push the public option and say that it was a crucial, important part. His broad outlines of "cuts the deficit, improves coverage" is too bland and not something people can rally around, and he gives the impression that he's ceding power and leadership to a less capable bunch in the legislative branch.

They wanted to see news stories about how "staffers close to the majority leader" say that chairmanships and other perks were on the line for any Democrat who talked about filibustering this crucial bill.

They wanted to see congressional leadership and the president campaign hard for an "up or down vote on healthcare" the way the Republicans did so effectively for the judge appointments.

But none of that happened, and the things that people care about died with a whimper.

My sense is that the Obama administration attempted a low-risk political strategy for itself. By eschewing any strong commitment to the public option, they made it easier to sacrifice something that they always figured they'd probably have to lose. It's telling that in all the coverage of the death of the public option, you haven't seen stories saying "Obama administration dealt huge defeat in Senate."

But in doing so, they betrayed a bond that the left thought it had with the young administration. And that's made this a much higher-risk strategy for the bill, and thus for the White House, too. If the Obama administration had been firmer on the public option and only let it go after grueling negotiations that ended with a concrete agreement on the bill, it's possible the administration would have had a better case to make to progressives. On the other hand, there are a lot of "ifs" in this debate, and there are plenty of ways that could have backfired, too.

Photo credit: By Jewel Samad/Getty Images

By Ezra Klein  |  December 17, 2009; 12:05 PM ET
Categories:  Health Reform  
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Next: Chat transcript: Reconciliation, cost controls and Lieberman, oh my!


On the other hand, perhaps Obama doesn't like the public option.

Posted by: ostap666 | December 17, 2009 12:14 PM | Report abuse

I think that HCR will suffer the same bad spin that the stimulus did. Obama is overpromising and underdelivering.

If he had put some political capital behind the PO or medicare buy in, if it is excluded from the final bill, he should say, "This is a good start, but it won't do much to lower premiums until there is meaningful competition in the insurance market. This is what we need to work toward." Be honest about what the bill will and will not do.

He overpromised on the stimulus, and by asking for too little, when his plan was cut by 100 billion, he should have said, "This is a good start, but the amount in the final bill is too small to make the economy grow. It may stop the freefall of the economy, but we will probably need more to get the economy going again." The frame is far better by being realistic about what compromising with conservadems and repiglicans is doing to his initiatives.

Posted by: srw3 | December 17, 2009 12:30 PM | Report abuse

there are 'ifs' in all strategies. as I said before, they decided to GO for it, but not to FIGHT for it.

They didn't just betray a bond, they betrayed a promise:

"But I will not back down on the basic principle that if Americans can't find affordable coverage, we will provide you with a choice."  (Applause.)

That was Sept. 10, in the joint session.

Posted by: andrewlong | December 17, 2009 1:02 PM | Report abuse

I do not share what 'srw3' is saying because Admin has not been over selling HCR as like stimulus bill. Further, people know Obama and Admin have always been ambivalent about PO. Folks are disappointed for that, but there is no betrayal here. Betrayal is by Senate folks - they brought the PO out of blues into Baucus bill knowing there are no votes for that, then pulled it further to the Left and essentially took Left on a ride; all along with full knowledge that this fat lady was not going to sing. It is the Senate Dem Leadership which cheated the Base for no reason. The had the honorable option of sticking to what works (Baucus bill as is) and they blew that.

Admin will blamed for cheating when they fail to ensure their own measures to control cost absent in the bill, which is what so far story is and seems to be the eventuality.

Obama has sold and is selling rightly today, HCR as cost control means. When Admin fails to block all loop holes Congress has introduced which will not control costs; that will be the real betrayal by the Administration.

The real stories which we are not reading are - Peter Orszag insisting on putting his own 4 measures in the bill; how Obama threatens to veto the bill if it does not contain cost control measure; etc.

Funny thing is that is what right politics demand today - President holding the line very tight for cost control / deficit reduction. It is just the suicidal instincts of this Administration that it is not following these obvious political imperatives.

Posted by: umesh409 | December 17, 2009 1:05 PM | Report abuse

Does anyone actually think Obama getting all veto-threaty about the public option would have done anything other than make it an even juicier target for Lieberman?


Nice context slicing, but the OPM non-profits will still be in the bill.

Posted by: eleander | December 17, 2009 1:05 PM | Report abuse

indeed, it was a calculated risk the WH took, so they didn't look bad whent he PO was pulled out. as it looked likely from the beginning it would.

but i would argue this resentment has been set up from the beginning of Obama's campaign. I was very worried that all these new voters were only concentrating on HOPE and CHANGE and getting swept away by the rhetoric and the possiblitites they all projected on to Obama, not the reality of the proposals he had been pushing.

the same "shock" that came when he fulfilled his campaign promise to escalate in Afganistan, is now coming when he "compromised his ideals" in getting the most signficant reform to the health industry in decades.

many thought they were electing a bold progressive leader, when in fact they were electing a smart, reality-based demorcrat, determined to get things done.

i hope this does get done. and in a few years perhaps Dr. Dean and the screaming left will appreciate the usefulness of reality, over the extasy of fantasy.

Posted by: priusdriver | December 17, 2009 1:16 PM | Report abuse

What I would add to the TPM reader's comments is that the white house consistently dissed the progressives. You heard about Rahm cursing at groups pressuring Ben Nelson in his home state (which were effective enough for him to respond to), the president lecturing us that we were too opinionated (paraphrasing) and now Gibbs calling Dean names. I don't agree with Dean on this action but I understand his feelings and he represents a lot of people. Gibbs attacking Dean is the same as attacking all those who agree with Dean or are sympathetic to his feelings of frustration. Plus he is correct that that this is a bailout for the insurance industry. I don't think the president and his staff understand that the Democratic base is also fed up with the raping of workers by corporate America.

I'm ready to start an alliance with the Libertarians, Tea Party (saner wings), Independents and others to develop a manifesto on ripping the financial grip of corporations (lobbyists) in politics.

I'm also aware that to make Lieberman, Nelson and other so called conservaDems irrelevant, we must elect additional Democratic senators. But the white house lack of leadership and the compromised healthcare and financial regulation legislation are going to make that pitch a very hard sell.

Posted by: wshudley | December 17, 2009 1:17 PM | Report abuse

Mr. Klein,

when you say "that's made this a much higher-risk strategy for the bill, and thus for the White House" you're spot on. The polling Markos has been citing about the unexcited base that doesn't plan to vote in the 2010 elections is symptomatic of the lack of fire and leadership democrats have sensed, as the TPM memo you cite implies.

I know I see no point in backing elected representatives who roll over for Joe Lieberman with my time, money and advocacy, though I can't bring myself to stay home for election day. Color me discouraged.

Posted by: prague_one | December 17, 2009 1:17 PM | Report abuse

I think its correct that a lot of the outcry is because Obama didnt fight the good fight, but of course he didnt because the public option was never that important to him. It was a possible means to the end of affordable universal coverage and nothing more to Obama. What we see here is just one of the ways in which liberals parts ways from what I will call "progressive leftists." The criticism here tends not to be that a means of cost control has been lost but that insurance companies are going to be able to make a profit. But liberals like Obama (and I acknowledge like me) arent bothered that insurance companies make a profit. What Obama wanted was simply to change the rules so that insurance companies could not make that profit by denying coverage for pre-existing conditions, or later, cancellation of the policy, thus helping to make coverage more universal. The affordability part primarily comes from the subsidies not the expectation of competition from the public option that was left on the table. Furthermore, those on the left seem to forget that when the medicare buy-in came up the opposition was not really from insurance companies but from doctors and hospitals. After all, the primary driver of premiums is not insurance profits, but the money that has to be paid out to doctors and hospitals. That is why meaningful use of the public option or medicare buy-in for cost control meant something based on medicare reimbursement rates, which has been gone for a long time, not because of insurance opposition, but because of the opposition of doctors and hospitals.
Getting this legislation passed as it is makes it more likely such a meaningful public option or medicare buy-in could pass in the future because the pressure for it will come from the cost of the subsidies to the federal budget and the concerns of individuals for the cost of their premiums. And we wont have to revisit all of the other contentious issues at the same time.

Posted by: gregspolitics | December 17, 2009 1:24 PM | Report abuse

I get this. It pisses me off to no end that Lieberman is now going around telling people that Obama thanked him for all his hard work. You yourself have documented how little hard work Lieberman has done, including a refusal to learn the broadest details. I have called numerous Reps and Senators, and signed god knows how many petitions (even though I think they are largely useless). Supposedly a jerk like Lieberman gets thanked? He should be out preening about how much he hates his new offices at the back of the broom closet.

Posted by: flounder2 | December 17, 2009 1:28 PM | Report abuse

I think Obama may have faired better had he treated the public option the way it perhaps should have been treated in hindsight.

His endorsement of the public option always seemed pretty weak to me. He was always trying to hedge.

What he probably should have done, or at least could have done, was to advocate for the public option as something that he really wanted, that would do a lot of good for the system, but on which he remained open to bargaining if something substantive were offered.

He never really framed it this way. I think if he had it would have freed him to strongly advocate for it with the understanding that he would do so as long as an offer of some kind were not extended.

Posted by: bcbulger | December 17, 2009 1:29 PM | Report abuse

People who want the public option/medicare buy-in (and I include myself in that group) shouldnt say that they wont support Dems in 2010 unless it is in this bill or the bill is forgotten. Instead, it would be much more useful to see this bill pass and then demand that Dem candidates advocate the addition of a public option/medicare buy-in in the 2010 election. Then if Dems retain control of the House and Senate (As i believe they would) they can claim a mandate for these policies and pass them through reconciliation with a majority in the 2011 budget. Since the subsidies and their manner of payment will already exist, there should be no problem of this adding to the deficit and, in fact, they can probably be adduced as deficit-reducing. Further, with the issue of the public option/medicare buy-in isolated, the public will have to understand that the ultimate issue on controlling costs is how much of the money produced by our economy should doctors and hospitals get.

Posted by: gregspolitics | December 17, 2009 1:31 PM | Report abuse

There is a big question here that focusing on a "technocratic" solution to healthcare may overlook:

Whether opposition now from the so-called left to healthcare reform as proposed is in fact salutary to the White House to "wake up" politically and in terms of its policy proposals.

Taking the narrowly technocratic view, that this bill provides some benefits and there should be no opposition or at least fuss from the Left, would mean an acquiescence by the so-called left to irrelevancy within the Democratic Party.

I personally am not sure if I would support Dean's position if I were a Senator and I am not starting a letter-writing campaign now (and neither is DFA..they are just doing fundraising) but it may have a very good effect of focusing the mind of those in the Administration who have taken their left for granted.

I think you are not giving Dean enough credit in terms of his political savvy. He after all is the engineer of the current Democratic majority.

Posted by: michaelterra | December 17, 2009 1:39 PM | Report abuse

I agree with gregspolitics. But my colleagues on the left may not work as hard in 2010 as they did in 2008, perceiving they didn't get "what they wanted." With all the blaming going on, I don't see ANYONE taking responsibility for the fact that the left did not work as hard on the public option as they should have. I'm not talking about Kos or Move on or HCAN. They worked hard. But the constituency out there? Did they march on Washington like the tea baggers? They did not. Did they shout very loudly about the public option at every town hall? They did not. So some of the responsibility rests with the rank and file here, the same rank and file that are screaming out now. It's too late for that now, folks. YOu had your chance. Accept responsibility and vow to work harder in 2010. That's the only mature thing to do.

Posted by: LindaB1 | December 17, 2009 1:40 PM | Report abuse

I think most progressives, like me, are just angry that the president didn't use the enormous people power that he had after the election to get a much stronger, ie progressive, bill. Instead, he and his team were smarter by far by making backroom deals with the various industries represented in order to win their approval for what is for citizens, essentially, weak tea health insurance reform and is not health care reform.

Posted by: goadri | December 17, 2009 1:42 PM | Report abuse

Oh please, goadri -- not real health reform? Health reform is only real if it includes a public option? Dean never supported that back in Vermont. Switzerland would be surprised to know they didn't pass "real" reform when they set up their nonprofit system. Get real. Get "real" reform by staying the course and fighting more effectively in 2010 for what you say you want.

Posted by: LindaB1 | December 17, 2009 1:58 PM | Report abuse

The issue is what cost containment measures are in the bill which represents a major change for the insurance industry. The president never voiced what these were. The public option was a concrete proposal which offered competition and the potential for tempering premium increases which the base understand. So without other stated goals and although neutuered by the end, the public option became the major premium containment measure. It also meant that even if the cost of the PO was the same as the other plans in the exchange, it gave people the choice of not handing over more money to the insurance industry.

Eliminating pre-existing conditions is not cost containment for the insurance industry because they receive a subsidy via tax payers dollars to cover people with ailments they had elected not to cover. What's maddening about the extension of Medicare to those younger than 65 is that the industry would still be able to sell Medigap policies.

The failure of any serious cost containment measures and increase revenue thus profits, for the insurance industry is a very bitter pill which the president by his lackluster strategy on this issue, is forcing the base to swallow. What was it he said in the speech before Congress...that he would be the last president to reform healthcare. If the result is handing over more revenue to an industry profiting on the deaths of its subscribers....heaven help us.

Posted by: wshudley | December 17, 2009 2:10 PM | Report abuse

This is neither a public plan nor a Swiss-style non-profit plan. It is a private, for-profit plan subsidized by public dollars.

Posted by: TXAndy | December 17, 2009 2:22 PM | Report abuse

Campaign commitments matter too.

During the campaign Obama distinguished his stance from Clinton's on the basis of "no mandates".

I think most are willing to cut some slack for Obama on the broken pledge on the mandates IF there is a strong, national, public option.

In the absence of that condition, Obama needs to drop the mandate. Otherwise he risks permanently alienating a significant minority of his base -- especially for many of us who will actually be subject to the new requirements and subject to what is going to be for all practical purposes a new tax on income in exchange for a crappy product.

LindaB1, in reference to your point:
1. The current House and Senate bills aren't the Swiss model, so your point is moot.
2. For many of those of us who have had experience in the individual insurance market in this country, leaving the private insurers in the game is a little bit like sending a repeat offending child molester into an elementary school with the "reassurance" that THIS TIME a hall monitor will occasionally make the rounds to ensure that everything is OK.

The people making the legislation and negotiating the deals -- and even some of the opinion makers -- are so insulated from the reality of the individual market, that they don't have any concept of the kind of anger that the mandates without a viable alternative mean for many of us.

So the insurers in the exchange may be on good behavior for a couple years, but few of us, I suspect, are under any illusions about what the long-term reality is likely to be.

Either private insurers need to be eliminated altogether, or consumers must be given a viable alternative too them from the start. Simply offering reassurance in the form of loop hole ridden "regulations" isn't sufficient.

Posted by: JPRS | December 17, 2009 2:24 PM | Report abuse


My criticism of this as being health insurance reform, as opposed to true health care reform, has nothing to do with the lack of a public option or Medicare buy-in. It has to do with the fact that the fundamentals currently in place will not change after passage of this bill. This is backed up with words from the horse's mouth as the president continues to say that if you like what you have, you can keep it. The significance of this bill is in how it attempts to regulate health insurance companies. It does far less to bend the cost curve or encourage more medical students into primary care.

Posted by: goadri | December 17, 2009 2:44 PM | Report abuse

Also, by making backroom deals with big Pharma and missing a chance to add negotiation of cost of pharmaceuticals to this bill, big business interests were protected at the expense of the citizen.

Posted by: goadri | December 17, 2009 2:49 PM | Report abuse


Most doctors actually prefer medicare because they pay in a more timely dependable fashion. This is much better to them than an expensive and time-consuming chase through the maze of a myriad of insurance company payment bureaucracies and schedules and gates all programmed to make it difficult to pay.

Yes, there is a loud, rich, minority of some doctors (mainly specialists) who prefer private insurance; but to assert baldly that doctors don't want medicare expansion is false.

Most doctors prefer a mixed system of private insurance and a publicly run option:

'In every region of the country, a majority of physicians supported a combination of public and private options, as did physicians who identified themselves as primary care providers, surgeons, or other medical subspecialists. Among those who identified themselves as members of the American Medical Association, 62.2 percent favored both the public and private options.'

Posted by: perhapsnot1 | December 17, 2009 3:17 PM | Report abuse

People don't mind if you lose a fight where you don't get *everything* you want, but they ultimately want to see you take a stand.

This is a great demonstration about how, by and large, politicians are who they are. They don't really change their temperament to changing circumstances, either because they can't or because they're so insulated in a bubble that they don't see what's happening. Obama's always been a conciliator, and that's the role he feels he was elected to take on. He's not the person to pick a fight just to convince an adversary to back down. He probably thinks that doing something like that is petty and not best for the country.

Posted by: constans | December 17, 2009 3:50 PM | Report abuse


HCAN is a large part of 'the constituency out there'

There was a march/rally on Washington. June 25th (Michael Jackson died, so the almost 20,000 people of all stripes in front of the capitol went unnoticed):

This was just one of thousands of actions small and large around the country 'the constituency' performed this year to convince lawmakers to write and enact good healthcare policy.

Exhorting encouragements to keep up the fight is fine. But blaming progressives for this crappy bill is foolish.

Posted by: perhapsnot1 | December 17, 2009 3:51 PM | Report abuse


In reference to the pharma deal, my beef isn't that the White House cut a deal, but that they negotiated such a p-ss poor compromise.

Getting support from the pharmaceutical industry in exchange for billions in new revenue is not a concession (even if part of that commitment was paid for with a down-payment of a hundred million or so in PR and advertising advocating reform).

If you cut a deal with Pharma, do it because you are leveraging concessions from another major player.

The White House and Congress have cut deals with every stakeholder except for the people who are actually financing the program.

Posted by: JPRS | December 17, 2009 3:51 PM | Report abuse


You said it better than I did!

Posted by: goadri | December 17, 2009 3:54 PM | Report abuse


In fairness, progressives -- myself included -- do bear some of the responsibility here.

We made the mistake of believing that Obama would actually honor his campaign commitments.

Unlike GOPers though, we tend to learn from mistakes the first go around.

There's an opportunity to rectify the situation in 2010 and 2012 if the Dems screw this one up by passing yet another taxpayer funded industry giveaway.

Posted by: JPRS | December 17, 2009 3:54 PM | Report abuse

It seems like the Democrats keep making concessions and still fail to get enough support. How far will this go before the White House will abandon "low-risk strategies?" That's not to say they were wrong to give it a try, but it seems to be failing.

Now, it's a Catch-22: They are, as usual, going to be viewed as either hard-handed leftists or weak losers. So why don't they forget compromise and push the bill that they think is best for the country? If they don't have 60 votes, why not force the GOP to filibuster? They always let the GOP bully them and then eventually the GOP will take back congress and the Democrats will cave to them.

Posted by: TheWacoKid | December 17, 2009 4:06 PM | Report abuse


I always felt we would have to compete with the Aetna-Blue Cross-CIGNA etc. 'constituency' to make any of those campaign pronouncements reality. I think a sizable number of grassroots organisations and individuals are hard at work on this. I do think there is a dynamic that Obama touched upon that to honor his committments...he'd need our help. Is it enough? I don't know, ask Joe Lieberman and Ben Nelson and Bart Stupak.

I don't see blaming progressives or blaming Obama as helpful. Yes, he (amongst others) backed Lieberman's current Senate existance and probably struck a deal with pharma, but I think it was to make health reform viable in a senate even more influenced by the power of the corporate lobby than the white house.

If he struck no deals, there may not have been any deals.

We have to keep working. And remain soberly optimistic.

Posted by: perhapsnot1 | December 17, 2009 4:20 PM | Report abuse

The public option and the massive overhead of creating a new government bureaucracy never made any sense, given that we already have a public option in Medicare that is the reason we started talking about reform in the first place.

Perhaps Obama is smart enough to see that the socialist public perception of the insurance companies as the root cause of our inflated costs is misplaced.

Perhaps Obama realizes that some simple regulatory changes to the insurance market- opening up competition across the states, preventing rescission, creating cooperative buy-ins, and allowing cheaper plans to exist can fix most of the issues. Of course, he clearly took the wrong stance on the employee tax exemption for employer provided benefits.

Perhaps he wants more attention turned to the core problem of overconsumption of overpriced services.

Posted by: staticvars | December 17, 2009 4:36 PM | Report abuse


Medicare is itself a Successful reform. It should be expanded.

For-Profit Health Insurance Corporations without being Effectively Regulated are A root cause of inflated costs but surely not the only one.
Perhaps you think anyone knows what you mean that the items on your little list will 'fix most issues'.

What are you talking about?

It sounds like that silly Republican proposal. You're not one of those clowns are you?

Posted by: perhapsnot1 | December 17, 2009 4:56 PM | Report abuse

eleander: you're asserting that the private coverage we might get via the OPM exchange-within-the-exchange lunacy will be equivalent to coverage under a public option or a Medicare buy-in? I don't see it.

I suppose I did take it out of context. But for the proper context, read the full section, in which the president gave his clearest and most compelling defense of a public option (just after Joe Wilson's outburst):

Posted by: andrewlong | December 17, 2009 5:07 PM | Report abuse

I beg to differ with many of you above -- there IS a nonprofit alternative still alive and being discussed and scored by CBO. It's the FEHBP buy-in to be managed by OPM. How come no one is talking about that? The plans would have to be nonprofit. So yes, Switzerland, we might be able to learn from you! And there IS regulation of insurance in the Senate bill. Tons of it. Regulation of how much a premium can be increased; regulation of medical loss ratios; regulation of benefit packages, etc. Have you read the bills?

Posted by: LindaB1 | December 17, 2009 6:12 PM | Report abuse

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