Leadership needed and required.

It's relatively new terminology but hardly a new concept. In the healthcare policy world, it's often discussed how much easier it would be to allow people to buy into Medicare or into the FEHBP, which is tantamount to the same thing--and really all you have to say to get people on board, which is why this whole debate is so frustrating.

Good point. I wnat a public option, I worry a bit that our side is getting a bit too emotionally invested in this point. If when all is said and done we have a reform package that's a huge improvement over the status quo but has no public option, I hope our side won't react by punishing Obama and the Dems. That's a sure formula for giving power back to the Republicans and regressing back to the status quo ante (or worse).

"...in just five years, we'll see a Democratic president pass a health care reform bill that's even more progressive that Howard Dean's plan..."

Another testament to the power of Bush to create unintended consequences.

I think this is a much needed perspective. Regarding Medicare and FEHBP, it's important to understand that FEHBP operates much more like a health insurance exchange than it does a single nationalized payer, like Medicare. The closest thing we have to what I would call the kind of public option being proposed is the Tricare program for civilian dependents of military personnel. This is actually a very good program, and it utilizes private contractors to administer publicly determined and financed benefits. We could do much worse than to have this kind of system on a national basis as an alternative to employer provided or even individually purchased insurance. I think what stops people from making the analogy is that it IS administered by private companies -- but so is Medicare.

On the one hand, the big picture matters most, but on the other hand, it is still important to know some details so that you know what the big picture actually is.

It's not 1936. It's not 1964. It's not 1993. It's not even 2008.

The horrific monstrosity that passes for health care in this country is catastrophically worse than it was even just one year ago, and the speed at which it is getting worse is increasing exponentially.

Incremental improvements, slightly tighter regs, minimal subsidies just won't cut it.

The truth is, even an Incredible Hulk of a public option probably won't cut it - only total and immediate single-payer will.

Pretending we don't really need a public option because it's so "new" isn't just not helpful, it's downright destructive.

Virginia, this isn't 2004. We were happy with a loaf half a loaf of shit in 2004 because the alternative was a whole loaf of shit from GWB. As has been noted, we have 60 senators and 60% of the house. We're not looking to eat any shit at all.

Health insurance premiums have skyrocketed just since 2004. The public option is a major proposal to help brake those increases. It is a proposal that is now very clearly needed. Its not just an extra add-on.

The biggest problem here is progressives saying "oh yeah, I can support reform without the public option" BEFORE we've lost a chance for the public option. Progressives are too damn rational and undercut their resolve. If we get soft on the public option now, we will have to support reform without a public option.

If we argue now that wow look what we're getting even without a public option so let's just be happy with that, we won't get a public option.

We'll only get a public option if we demand one and are willing to go to the mat for it. The struggle for this legislation is far, far from over. Settling now for less is a really, really bad idea.

Barbara's clarification is important.

But the big picture remains. The message here is, Medicare may not be perfect but it provides coverage to millions of seniors who would otherwise go without. We want to a) expand the benefit package, and b) open it up to people who are under 65 or don't have kidney disease. And if you can't afford to buy in, we'll give you a voucher that you can use to pay for it or, if you prefer, you can take that voucher to a private insurance company or Blues plan and there's you insurance. Boom, universal coverage. Boom, public option that everyone can understand. Then the only argument becomes how do we pay for it.

All I can say is it is a good thing genera;;u politicans are not medical personnel taking care of a critical patient. The patient would have died with all the political dithering and clamor.

The patient would have died with all the political dithering and clamor. -mljohnston

On the contrary. If each member of Congress were a physician, the damage would be minimal. Instead, their unwillingness to act in the best interest of the citizenry results in millions of sick and dying people.

What if corporations voluntarily added 1 cent to every unit of their product (boxes of cereal, hubcaps, underwear, etc) to help fund healthcare ?

It wouldn't have occurred to me to ask, "But will it have a public option?"

No, it probably wouldn't have. Unless, of course, you had a President who began this whole process by talking up the importance of the public option in his health-care reform plan. He & the rest of the Democrats have handled this so piss poorly that not only will there be no public option in whatever bill materializes, but there will be no provision for something as anodyne as counseling related to living wills & hospice care. Health-care reform is fast becoming health-care "reform." And it's being gutted by Republicans & industry hacks while Democratic leaders stand around & watch helplessly.

coral,

Relying on the altruism of profit making ventures to fund health care seems like a great way to start investing in bridges.

Nice to see you can bend over.

Now get out of the way.

I largely agree with Chocolate Thunder, but I just want people to realize that when they say "Medicare or FEHBP" they are talking about very different programs.

Regarding cost control, I think what we are seeing in Massachusetts is essentially what we will see at the federal level. You can't really contain costs until you have universal coverage because it's hard to see with clarity where the cost centers are -- and certainly much harder to tackle them -- when you have the ability to reduce costs by utilizing the handy trap door of reducing coverage and benefits. But in fairness to employers, this is virtually the only mechanism they have to reduce costs, and given concentration in markets, insurers often don't have any better ability to reduce costs either. But that realization is much more easily avoided when you don't have a commitment to universal coverage.

Healthcare reform is meaningful only if it has, as Paul Krugman said, "regulation, mandates, subsidies and competition".

Mandates were the big thing during the Dem primaries remember? As it turns out, Obama isn't that much against mandates even though it is true that is not the centerpiece of his plan.

The public option is a compromise between the Democratic plans of the past years, and John Conyers' single payer plan, and is one (the best) way to achieve competition.

Boy, Steve, as I noted yesterday, you and Ezra are indeed in full "managing expectations" mode. How effing sad.

It wouldn't have occurred to me to ask, "But will it have a public option?"

Oh, as a counterpoint, I figured that the first Dem POTUS after the GWB interregnum would naturally push for single payer.

Ezra is wrong. Kerry's plan did include a public option.

http://www.princeton.edu/~starr/articles/articles04/Starr-HCbigchoice-10-04.htm

I'm reading in this thread and elsewhere a lot of attitudes that worry me, along the line of "it's got to be this way or it won't mean a thing" and "why can't those wimpy Dems just take control and give us everything we want." This shows a serious lack of understanding of political realities.

But what is worrisome is all the rumbles about turning on Obama and the Dems if the final product is not exactly to everybody's liking. This is going to be long fight and we might not get it all on the first go. But to turn on the Dems and thus give the republicans a chance to take back power would be the height of folly. That way we would assure that all of our gains would be lost.

Don't let the perfect be the enemy of the good. Think, people!

But not one of them included a public option as part of the policy.

Could be that the reason for that is that very serious people (and those wanting to be considered as such; e.g., Ezra Klein) have constantly been saying that half a loaf was all that was feasible. They weren't even trying to advance a progressive argument. That's how EK got his WaPo gig. A very serious person, indeed.

I'm amused that the public option is such a controversial topic for conservatives. For decades we have heard about the importance of allowing government and private entities battle in a free market for a public good similar to health insurance: education. The conservatives have demanded a voucher system in which people are free to use personal and public funds to "buy" public or private education in open competition.

Somehow in the health insurance arena, this conservative concept is unacceptable and threatens the very fabric of our society.

The use of downward counterfactuals ("it could be worse") as a way of prospectively rationalizing strategy strikes me as maladaptive, Steve, as it generates complacency. (Using it after a public option is passed, if that happens—as an ego-bolstering technique—is different.)

Further, just mentioning "a public option" without more consideration of what would be needed to achieve its stated goals strikes me, at the very least, as a bit careless. Make the case for a public option on the terms that its proponents have stated rather as some comparison to Howard Dean's proposal from 2004.

In Dean's defense...we didn't know then what we know now. Recission was not as obvious nor were the outrageous salaries resulting from that practice. The more Wall Street got involved in HC the more a public option became necessary...and the more obvious its necessity became to all. The private ins companies skyrocketed in death care and profit. "Sicko" made it so much more clear as it exposed just how bad it had become.

I'm confident that if the exposure of the HC ins industry we have today were available when Dean first made reform proposals it would have included a 'public option'

The biggest strategic mistake the Dems/Obama keep making is they keep asking for what they want instead of overshooting-- they should have proposed a single-payer system and taken *that* off the table and made having a "public option" a compromise. Hell, they're already being accused of being socialists and they're not even asking for anything that is remotely socialist.

They don't seem to learn that they need to ask for MORE and then settle for LESS; instead they ask for what they want and then get nowhere near it.

No, I'm not holding my breath.

Jeff W --

Totally down with your first point, but the delicious creamy filling your comment is found in the second link. Thanks for that. It's worth pointing out that one of the commenters, Badtux, offers an embarrassingly simple & extremely effective way of guaranteeing that a public option works -- eliminate the existing health-care plan for federal employees (ALL federal employees), and migrate all of them into the public option. Naturally, the plans within the public option would need to be tiered, but this isn't rocket science.

any reform has been considered better than no reform lending support to all past "reform" plan. But it wasn't until Michael Moore's "Sicko" that there was widespread understanding or exposure of the cancerous effect insurance companies were having on America's healthcare system or that no improvement in America's overall healthcare picture can occur as long as they remain in the driver's seat. No one should make any mistake that the purpose of the public option is to get insurance companies out of the healthcare business and pave the way to single payer (which is exactly as it should be).

Getting insurance companies out of healthcare is a very new dynamic.

Correction to my earlier comment: "rather than as"

Thanks, junebug. I honestly don't get the point of the post except as an exercise in pure rationalization. Following on the heels of Steve's Obama-as-FDR post, it makes me reassess Steve's perspective.

One can reasonably argue that a robust public option is good policy or not. One can even reasonably argue, much less convincingly, that a weak public option might eventually lead to a stronger one. (That's the Paul Begala "look how 'cramped, parsimonious, mean-spirited and even racist' Social Security was when first enacted" editorial.) But this weird appeal to an unspecified "public option" that "reform advocates" want (as Jacob Hacker originally proposed? as constituted in HR 3200? what's Steve talking about?) on the basis that it is "even more progressive" than what was proposed in 2004? It's not intelligible.