ObamaCare: Public Option, Private Hot Potato

posted at 12:03 am on October 8, 2009 by Karl

Although the Democrats think they are on a roll with their planned takeover of the US healthcare system, things continue to look dodgy for their government-run insurance scheme:

In a meeting [Wednesday] between House leaders and rank and file Dems in the capital, Nancy Pelosi frustrated many liberals by suggesting that they consider a watered-down public option as a way of getting health care through the House, a top House liberal says.

Pelosi’s suggestion prompted some aggressive pushback from some liberals, who demanded to know why the House leadership wasn’t throwing its weight behind the most robust form of the public option — one that reimburses providers at Medicare rates plus five percent — when a large majority of House Dems backs it.

But not 218 Democrats, apparently.

Chris Bowers explains the larger impact:

Every step of the process is important in this campaign. If the House passes a weaker public option with negotiated rates, then it is less likely that any public option will end up in the final bill. If the Senate does not include a public option in the merged Finance and HELP committee bill that is sent to the floor of the Senate, then it is less likely that a public option of any sort will be included in the final bill.

FDL’s David Dayen focuses on the Senate side of the question:

I’m hearing from sources about a letter to Harry Reid from a collection of liberal Senators, led by Sens. Jay Rockefeller and Sherrod Brown, insisting that Reid publicly commit to putting a public option in any health care bill that reaches the Senate floor.

There’s a big difference between having a public option in the bill before the fact or trying to get it in by amendment. It’s likely that amendments to the bill will require a 60-vote threshold, therefore it would take 60 votes to get a public option into the bill if it’s absent, or 60 to get one out of the bill if it’s present. Nobody has said that there are those numbers of votes to do either of those actions, so, whether the bill comes to the Senate floor with a public option or not is a crucial decision. The four people in that room making that decision are Max Baucus of the Finance Committee, Tom Harkin of the HELP Committee, Harry Reid and someone from the White House. A lot of this will depend on the White House’s inclination, and they certainly floated their support over the weekend. But Reid’s public statements have been noncommittal.

Indeed, Reid has been trying to toss this hot potato into the laps of the White House. All of which is why stories about Reid having some evil genius plan to bring the final health care bill to the floor without a public option do not immediately give me a case of the vapors. To the contrary, the more stories there are about proposals for state-based “public options” or having a “public option” with a state opt-out, the more it sounds like the Democrats not only lack a consensus to have a public option, but are dreaming up things to be for to explain what they would have voted for, should someone ask after the idea collapses.

Of course, as a policy matter, the Democrats could enact a government takeover of US healthcare without the “public option.” However, if the “public option” fails, or is watered down enough that it becomes unpalatable to hardcore progressives and the nutroots, the entire project might lose a great deal of momentum.

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