Bullshit Philosophy

Half-assed political and religious commentary from a cynical left-winger

Thoughts on the “public option”: bad policy and bad politics

Posted by Kevin on August 30, 2009

“I also understand the term used often by our hero Ted Kennedy, that “the perfect is the enemy of the good”. However, in this case, I’d like to turn that spin around and say that, in the instance of the public option, half-assed and inadequate is the enemy of the necessary and the acceptable.” –Steve Steffens [article link]

In comments to my last post dealing with healthcare, I was criticized (rightly, as I’ll explain) for supporting a public option. I thought it would be a good idea to expand on my thoughts on the issue.

I’m definitely a single-payer supporter, and while I’ve never been one of those progressives who says “Single-payer isn’t going to happen right now, so lets not even bother talking about it,” at the time of that post I thought the public option was an acceptable compromise, at least better than doing nothing. But the more I’ve read about it, the less sure I’ve been.

These days, I’m of the opinion that it might be better to just hold out for single-payer, and that as terrible as the status quo is, the substantial risks associated with even a well-designed public option (let alone the crappy bill that will almost certainly come out of Washington) could make doing nothing the better choice. I wouldn’t say I’m opposed to the public option, more like ambivalent; I wouldn’t see it as a bad thing if a decent public plan passed, but I’m not really willing to expend any effort on its behalf.

It’s amazing to me how virtually everyone who believes in the basic concept of universal healthcare agrees that single-payer is the best way to achieve it, and yet even among very progressive people it’s seen as almost taboo. If they mention it at all, it’s almost always along the lines of, “Well yeah, in a perfect world we’d have single-payer, but…”

But what? But, as “progressive” Congressman Henry Waxman put it when asked why he removed his co-sponsorship of H.R. 676, the House single-payer bill, “It isn’t going to happen.” We see this often from politicians like Waxman, and Obama as well: they support single-payer when they’re out of power, but once they get any actual ability to implement it they suddenly start backtracking, talking about how “we need to be realistic”. Gosh, it’s almost as if they aren’t really serious about it and they’re just telling us what we want to hear!

Still, he’s absolutely right; I think we can be pretty certain that a single-payer bill, even if by some miracle it passed the House, stands little-to-no chance of surviving the Senate. But instead of insisting on what they know is right, many like Waxman are rallying around a “compromise” plan that’s far more complicated and expensive, and far less effective, even in the best case scenario.

I think progressives made a huge mistake in giving up on single-payer so easily, in not even putting it on the table. There is no “right” time to start talking about it. It might not pass today, but if we want it to pass in the future then we need to be laying the groundwork now, and at least keep the idea alive until then. This is the position of Dick McCormack, one of my state senators and primary sponsor of a single-payer bill here in Vermont. Even though by his own admission the bill is going nowhere, he says it’s important to keep people talking about it, and keep its failure from becoming a self-fulfilling prophecy. As I’ve said before, if nobody’s at least talking about a given position, that alone guarantees it will never happen.

Even if you disagree with me on the efficacy of the public option, I think it’s clear that by compromising so early, progressives ensured that they’d have trouble getting even that much, that the final plan would be watered down even further. Progressives have a long proud history of ignoring one of the basic rules of negotiation: asking for twice as much as what you want in the hope of bargaining down to something you can live with. Instead, we start from a compromise position, and then we’re surprised at being expected to tone things down further. As a result, instead of single-payer being the Left position and a strong public option being the compromise, the public option is the Left position and Blue Dog position is the compromise.

But isn’t the public option at least a step in the right direction? I won’t get into the specifics of what I think its problems are, because others have done it a lot better than I could. Here is a great article from Physicians for a National Health Program explaining the problems with the public option and why we should insist on single-payer instead.

Generally, I think the public option is very hard to do right, and given the current Congress anything that could actually pass will almost certainly not be done right. In fact, it’s looking increasingly unlikely that the final plan will even have a public option, or do much of anything other than funnel money to the insurance and drug companies. (Some, like Matt Taibbi and Glenn Greenwald, argue that Obama and the Dem leadership were never really serious about having a public option in the bill and planned from the beginning to bargain it away in order to placate the lobbies.)

In addition, as the PNHP article points out, there’s no reason to believe that incrementalism would somehow lead to single-payer, as some proponents of the public option argue. That hasn’t happened anywhere it’s been tried; I would argue that minuscule reform of this type just has the effect of delaying real reform. Democratic politicians are the experts at this: doing just enough to shut people up for a little while, without seriously challenging the interests of their corporate backers.

If the public option does fail, then in addition to creating an enormous, entirely deserved backlash against the Democrats it will probably sour the public on the basic idea of universal health care. This is already happening in regard to the stimulus and government intervention in the economy, as Chris Bowers argues at Open Left:

Whether or not the Democratic trifecta actually passes progressive legislation, the legislation that is passed and the policies that are followed will still be perceived as progressive. We simply can’t avoid that.

For example, right now the stimulus package pretty much equals left-wing economic philosophy in the eyes of the American people. If it doesn’t produce results, we are all going to see our ideas become discredited in the eyes of the American public, even if we thought policies of the Democratic trifecta did not go nearly far enough. The country is never going to say “well, that idea didn’t work, so let’s try a more extreme version of it.” People just don’t think that way in America.

Given the inadequacy of the public option and the improbability of passing single-payer on the national level in the near future, where do we go from here? I think we need to shift attention to the state level, where there’s often a much greater possibility of getting real reform. The main thing to do on the national level is to keep the federal government from standing in the way of state efforts to do the right thing. A key part of this is making sure the Kucinich amendment, which would make it easier for states to pass single-payer, makes it into the final healthcare reform bill.

We also need to work on reforming the Senate, which is obviously the main obstacle to real healthcare reform (and progressive reform in general) on the national level, pretty much no matter which party is in charge. David Sirota points out that it’s unresponsive by its very design, giving enormous weight to a group of Senators representing an extremely small number of Americans. As a result, Sirota says, the healthcare debate is being controlled by a small handful of legislators from small, rural states. The first step to reforming the Senate, Tom Geoghegan argues, is to get rid of the filibuster, the primary weapon of the opponents of reform. This entails a bloody battle, but it’s absolutely necessary.

And, of course, we need to ignore the false promise of bullshit “incremental” reform that just tinkers around the edges, and support policies that go to the root of our problems. In addition, we need to be suspicious of politicians like Obama who care more about ensuring a legislative victory for themselves than they do about actually doing something substantive.

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