Tuesday, October 27, 2009

Optional Option

Josh Marshall has a good take on what healthcare reform with a public option opt-out means for the future of the bill and the political ramifications for the people who will vote for or against it.

While it’s not ideal, an opt-out gives you the reality of a public option whereas the other compromises give you things that superficially sound similar but actually don’t accomplish the same purpose. This was my sense of the policy dynamics when I first heard about it. And I have what I think of as a decent layman’s understanding of health care policy questions. But since the idea was floated early this month I’ve made an effort to canvass the views of the people who I consider most knowledgeable on these questions. And I think I’m on solid ground in saying that there is a consensus among the people who understand these issue best on the reform side that this is a good pragmatic compromise that may not be perfect but gets you most of what the public option concept is meant to accomplish.

Equally important is the politics. In two key ways the ‘opt-out’ flipped the political dynamics entirely. A big argument from Republicans was that the public option would force people into ‘government health care’ or in various other ways destroy the universe. The opt-out just says: ‘fine, then don’t allow it in your state. Next …’ That takes a lot of the wind out of the sails of that argument. And, more pointedly, conservative and moderate Dems who were afraid of voting for the full public option seem to think that this gives them sufficient cover to vote for it — at least for the procedural 60 vote threshold, if not for the bill itself, which will take 50 votes. But that’s all that’s really necessary: getting past cloture.

Basically what the bill Senate Majority Leader Harry Reid (D-NV) put forward yesterday represents is a compromise between what the hard-core liberals wanted — mandated single-payer universal government-run health insurance — and what the Blue Dogs and nervous moderates wanted — nothing really more than fine-tuning of the current system dressed up as “reform.” The Republicans basically opted out of the entire process by offering nothing constructive unless you consider a lot of scary stories about the horrors of competition and government bureaucrats taking jobs away from corporate bureaucrats who think a healthy baby is uninsurable and being raped is an exclusionary pre-existing condition is healthcare reform. Oh, and tax cuts. Always tax cuts.

The bill that Sen. Reid is backing is by no means the final version, but as Rachel Maddow noted last night, at least it’s a bill, not a bunch of proposals floating around trying to find a place to land. At least we have something to work with now, and even if it provides the GOP and the insurance industry with a sitting target, it’s going to be interesting to see how they claim that an optional public option is somehow the evil mandated oppressive Obamacare that they’ve been freaking out about all summer. I have no doubt that they will, but half the fun will be watching them do it.