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The Obama administration doesn't care about the public option and Congress doesn't care about cost control

Color me unsurprised that Barack Obama didn't mention the public option in his remarks to the Senate last weekend. One of the dynamics that hasn't really penetrated in this debate is that the Obama administration is mainly interested in the cost controls. The president will throw the public option overboard if Susan Collins asks him nicely. Conversely, Peter Orszag will lay down in traffic to save the Medicare Commission. Generally, Democrats want to reform the health-care system because they want to cut the number of uninsured. The Obama administration's commitment to health-care reform stems from their belief that it's the first step towards cutting long-term deficits.

That's why it's been so depressing to watch the Republicans and conservative Democrats who base their opposition on cost control prove stubbornly unwilling to cut a deal that would control costs. The Obama administration would support pretty much any cost containment device that could pass Congress. They'd cap the employer tax exclusion, create a Medicare Commission, bundle every hospital payment in the country, support a strong public option, whatever. But there has been no bloc of votes interested in a deal along those lines. Instead, the conservative Democrats have contented themselves with killing the public option and the Republicans have committed themselves to killing the bill. That's left liberal Democrats like Jay Rockefeller to advocate everything from progressive ideas like the public option to conservative ideas like the Medicare Commission.

By Ezra Klein  |  December 7, 2009; 2:35 PM ET
Categories:  Health Reform  
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Comments

Isn't it nice that when Dems are in power, they focus on the deficit, and when Reps are in power, they focus on taking care of their constituents!

Posted by: AZProgressive | December 7, 2009 2:41 PM | Report abuse

If the medicare commission were split apart from the rest of the gargantuan bill would it have the votes to pass? Same with the public option- if its good policy then why does it have to be wrapped up into the rest of this garbage?

Posted by: spotatl | December 7, 2009 2:45 PM | Report abuse

You paint the Obama administration as the responsible stewards of the budget. The actually policy is win at any cost. Obama's backroom giveaways were bad policy and huge budget busters. Now he is simply courting so-called centrists, all of whom are corporate shills and several of whom have an expressed desire to destroy the social safety net and shift to a less progressive tax structure. He is making a mess of it too, refusing to negotiate forcefully and instead letting them add increasingly outrageous demands.

Posted by: bmull | December 7, 2009 2:57 PM | Report abuse

"That's why it's been so depressing to watch the Republicans and conservative Democrats who base their opposition on cost control prove stubbornly unwilling to cut a deal that would control costs."

Absolutely correct. And it is comical in a serious way, to listen to wingers like Mike Enzi today attack the dem bill by quoting industry people (Like Ortiz from the Mayo) who say the bills cost control programs are not strong enough. When it is they (GOP) and a few blue dog dems who are to blame for this. Irony all around.

Posted by: arnold104 | December 7, 2009 3:26 PM | Report abuse

"One of the dynamics that hasn't really penetrated in this debate is that the Obama administration is mainly interested in the cost controls. The president will throw the public option overboard if Susan Collins asks him nicely. Conversely, Peter Orszag will lay down in traffic to save the Medicare Commission."

This seems to imply something very, very disturbing about the American "liberal" party.

So the debate over the social safety net in this country has basically come down to "cut it as much as you can without pissing people off" (Socialist!) vs. "bleed it dry by diverting all that tax money to large corporations" (sensible compassionate conservatism)?

Posted by: NS12345 | December 7, 2009 3:40 PM | Report abuse

Sad Times at Ridgemont High.

Posted by: pbasso_khan | December 7, 2009 4:09 PM | Report abuse

Important aspects of cost control that Obama et al haven't come close to embracing:

1. Physician practice/reimbursement reform
2. Structure of Medicare benefits

Posted by: wisewon | December 7, 2009 4:12 PM | Report abuse

This post explains perfectly the entire health care reform process to date.

Posted by: eRobin1 | December 7, 2009 4:31 PM | Report abuse

This really is one of the significant problems of the health care legislation: Obama knows that health care is an important issues for Democrats, but it's never been his personal signature issue. His personal stake is more in his signature issue of "getting people to the table" to come up with an agreement, not any kind of specific vision or belief about how he thinks that agreement should work.

Obama is really missing this opportunity to enact a bit of a political version of the "Ledeen doctrine": "Every ten years or so, the Democratic party needs to pick up some crappy little Republican interest group and throw it against the wall, just to show the right wing we mean business."

Posted by: tyromania | December 7, 2009 6:08 PM | Report abuse

There seems to be a contradiction here. A strong public option based on Medicare rates would be (according to CBO) one of the better ways to reduce the long term deficit. And yet the administration is completely indifferent to whether there even is a public option let alone how the public option sets its rates. I'm not sure how Ezra can square that with the administration mainly caring about cost control. It would be more accurate to say the administration just wants a legislative victory and doesn't care all that much about the content of the bill.

Posted by: redwards95 | December 7, 2009 6:22 PM | Report abuse

Not quite true -- apparently Warner and a group of freshman Dems are working on a cost containment amendment, and Collins/Lieberman have filed another amendment along those lines. So there's hope yet that cost containment will remain and even be strengthened!

Posted by: annielev | December 7, 2009 6:39 PM | Report abuse

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