Outside Capitol Hill, too, what has appeared to be the unceremonious dumping of the public option has already lost Obama points inside his own party. “Without a public, Medicare-like option, health care reform is a band-aid for a system in critical condition,” blogged Robert Reich, a University of California at Berkeley professor and Bill Clinton’s former labour secretary. He blamed Obama for its apparent demise: “It’s because the White House has never made an explicit commitment to a public option.”
Will the progressive Democrats make good on their vows to vote against reform if the final legislation does not include a public option? Will they actually risk handing Obama—and their own party—a major defeat before the 2010 mid-term elections? Probably not, though they can hardly say so at this point in the process without losing a major bargaining chip.
There is plenty of reason for them to swallow their pride, says one veteran of the Clinton health care wars. “It behooves progressives to keep the big prize in sight as we go into the stretch on this debate,” says Will Marshall, president of the Progressive Policy Institute, a think tank for moderate Democrats which had a reputation as Bill Clinton’s idea mill. Marshall said Obama is right to show “tactical flexibility” on the issue. “The central fallacy is that the public option is the core structural reform needed to get universal coverage at an affordable cost. We can get there without it. To me it’s an example of ideological passions crowding out a very pragmatic view of what reform can and should accomplish.”
Even without a public option, the health care reform legislation stands to include many substantive changes for Americans. Most likely a final bill will achieve near-universal coverage through some combination of a legal requirement for all individuals and most employers to buy health care insurance combined with subsidies for lower income people paid for by tax hikes on upper income earners. Tough new regulations would prevent insurance companies from denying coverage to people with pre-existing medical conditions, or from dropping their coverage when they get sick, or from limiting their coverage in the case of catastrophic illness. There would also be a Health Insurance Exchange, where individuals could compare and choose the most appropriate plan for themselves. The reforms under debate also include a variety of efficiency improvements, from electronic health records to studies on the comparative effectiveness of various treatments to an emphasis on preventive care.
Obama has already made more progress than Clinton did, Marshall insists. “I was there in 1994 watching closely, and the insurance industry was leading the charge against the bill—and this time they are on board. They don’t like the public option, but they have agreed with main structural innovation, which is the health exchanges, and the strict rules against denying coverage or taking it away on medical grounds.” He adds: “Progressives ought to take that in a heartbeat.”
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