but nearly all believe there are other provisions [than the public option] that will prove more important in the grand scheme of things.

Yes, but only because the public option that passes will suck, and suck hard.

In the grand scheme of things, there is nothing more important than a robust public plan, open to all and with the full negotiating strength of the federal government.

If there's something more important or effective to health care reform, I sure haven't heard it. And I read this blog every day. So enlighten me, please.

My view from here in the Sonoran Desert or Arizona, is that the Right was pre-ordained to oppose health care reform, from its inception into the public discourse.

And why?

Arizona's Senator Kyl, as former Policy Czar and now the Number Two Jefe-Honcho, was a child when he was sitting on the knee of the Chamber of Commerce. And when achieving his current leadership postion, the U.S. Chamber of Commerce "cleared the way" for his ascension. Thusly, any thing that displeases the Chamber, Kyl will be its foremost champion in the Senate. Consequently, all this voodoo, is really nothing more than smoke and mirrors for public consumption, and distracts from their original opposition and which was pre-determined in the back room.

Jaango

I read a few topics. I respect your work and added blog to favorites.

Without the public option, where are the premium control measures in reform? In other words, what else is there to keep insurers from continuing to gouge the hell out of us and our employers? Won't larger subsidies without the public option just empower them even more?

In addition, it's abundantly clear from CBO scoring that the public option reduces the cost of health care and reduces the deficit. The more robust the public option in terms of both the number of people eligible for coverage and the ability to negotiate with providers, the greater the ability to reduce deficits.

This isn't the first time that Ezra Klein has dismissed the importance of the public option, but for the life of me, I don't see where he's coming from.

Subsidies? You mean take tax dollars and give them to health denial companies?

Excuse me but FUCK THAT!!

Think you're right. The public option is popular and is only going to grow more popular. The Republicans do themselves no favors by positioning themselves as the party that doesn't support the public.

This is only the beginning. And the Democrats have shown they're the ones on the side that people care about.

Wait, let me rephrase my last comment:

We're going to subsidize payments to the health care denial companies who will continue to recind people'S policies when they most need insurance AND charge us out the nose for the pleasure?

Jeebus, I am already paying $1000 a month AND I AM HEALTHY! How much are they going to charge me to just cut me off when I actually need it?

So, TOTALLY FUCK THAT!

The most important reason to support the public option is that it will then exist. The conservatives claim that it will be a slippery slope to socialized medicine, and while that's probably not the case, it probably will be a slippery slope toward a more widely available public option at some time in the future. And not only that, the experience of Medicare and Medicaid and the VA and all that is proof that people will get used to it.

But I am otherwise tired of the wonks discounting the public option. If they think that the health care reform plan needs to reform the cost structure of our health care system, then it would be nice for them to make some realistic policy suggestions. Instead all they do is wring their hands and go on NPR whining about how nobody understands that the real problem is the "system." But because they're "non-partisan," they don't think it's appropriate to suggest any actual ideas that would reform the system in any meaningful way within a relatively short period of time.

If we had real policy-wonk momentum towards price controls and reimbursement based on evidence-based guidelines, then we wouldn't have to worry about wimpy crap like the public option. So don't give me any "wonks think it's weak tea" shit. Of course it's weak tea, but they're not helping brew the pot!

But looking back over the last several months, we see that reform opponents a) went after the single most popular element of the reform plan; and b) largely ignored contentious provisions that may have been vulnerable to attacks from the right.

Yet over that time, support for the bills has decreased, and opposition has increased.

Chris: In addition, it's abundantly clear from CBO scoring that the public option reduces the cost of health care and reduces the deficit.

The only thing that is "abundantly clear" from the CBO scoring is that the total federal expenditure will be great. Whether it costs less or more, increases or decreases the federal debt depends on untested assumptions.

...making it more likely that they'll fall a bit short of where they otherwise could be.

It remains to be seen what kind of concessions the Republicans and Blue Dogs will get on those other matters.

The opt-out should be supplemented with a requirement: a state will be required to have (and the governor will be required to certify that it has) a substitute non-profit publicly-operated or sponsored plan on a state basis (only for the very largest states) or a regional interstate compact (for a sufficient pool, the lowest level of which should be defined in the legislation) that offers comparable savings to the Federally-chartered option. Regions could be the size of several European countries, so leverage even with the restricted universe of insureds should be considerable. Start-up funding (loans) should be made available.

This adheres to the principle that because coverage is being mandated, it is unfair -- indeed, un-American -- to force people to get their insurance from for-profit companies. As with police and fire protection, and other such life-and-death matters, many do not believe it is possible in the health insurance field for a for-profit company to avoid the inherent conflict of interest between providing insurance -- paying the claims -- and maximizing profits. There must be an officially recognized non-profit alternative, and only a publicly-sponsored entity can fulfill that objective.

One predictable objection is that auto insurance is mandated by states without a non-profit public option available. Besides the fact that claims are based on objective criteria -- liability a court either has or is predicted to find -- auto-insurance is not 17 per cent of the gross domestic product, or 15 or 20 per cent of a family budget.

"...over [the last several months], support for the [health reform] bills has decreased, and opposition has increase"

MatthewRMarler is lost.

This way to fantasy land --> http://www.RedState.com.

Are we reading the same bill. Without the public option all that is happening is private ins. is getting millions of new customers, heavily subsidized by tax dollars, in exchange for getting rid of the pre existing condition clauses in their policies.

The public option as it now stands is virtually meaningless allowing only a few to be covered and they would pay (subsidized) higher premiums. The only benefit the right is afraid of is it opens the door for gov. involvement which may in the future be expanded and head towards a Medicare for all program.

Ezra is ignoring the real give away this is turning out to be to Private ins. and doesn't even mention the best part of the bill which is expanding Medicare and Medicaid while cutting out waste.

What ever repubs can do to water down or destroy this reform bill they will try. What has become evident is how bought and bribed so many of our legislators have become, showing just how much they will work against the demands of the people for the special interests that own them.

Without the public option all that is happening is private ins. is getting millions of new customers, heavily subsidized by tax dollars, in exchange for getting rid of the pre existing condition clauses in their policies.

Thank you. At least with the public option a lot of the money goes back into health care instead of for corporate profits.

Let's be clear...Rahm Emanuel Obama has already bargained away the Public Option...the WH is totally against it...just like the deal Obama made with big Pharma in secret...this is a huge giveaway to private ins...all in exchange for the big campaign donations...whatever, but the WH is against the PO which is why they wanted the "Trigger" so bad because that is no PO at all also.

Reid is standing in Obama's way with his (still weak opt out version) so enter Joe Lieberman (Obama's mentor when he was a jr senator) to block out any PO version (which is the same as Obama's "trigger" choice. Remember it was Joe who also made sure those torture photos could never be realesed by FOIA which Obama couldn't get done himself).

Ezra's thinking is muddled. Only a robust Public option is real reform but any PO version will open the door to expansion...though I doubt we are 'allowed' to have it no matter it's what the majority favors.

In a spirit of not entirely unwarranted cynicism bordering on paranoia, perhaps the argument over the "public option" has been a bipartisan effort to stage a contentious debate over something that, in the only form that it is being seriously considered, is useless or even worse than useless. Whoever wins this faux debate, both sides can claim that they fought bravely for their constituents, and some Americans may even be convinced at they affected the outcome.

In short, Mr. Klein ignores the third possibility that both sides were cynically using the "public option" to distract voters from a bill that may end up being little more than a massive subsidy of the present system, with limited reform around the edges.

I would really like to believe that I'm being paranoid.

"Now, it's certainly possible that the public option, or some compromise version of it, will be scuttled in the end."

There's a fair chance that wouldn't pass the House.

The public option as it now stands is virtually meaningless allowing only a few to be covered and they would pay (subsidized) higher premiums.

Benen's analysis is weirdly obtuse and the comments here are uninformed. The reality is that the public debate about reform has been in the context of almost complete ignorance of the actual substance of the bills being discussed and the pundits and politicians have aided and abetted that for various reasons.

Three months ago, in these very comments people who supported the public option were claiming exactly what Benen says the crazy conservatives believe about the public option. Basically, in the public mind, the public option would be some form of Medicare-for-all. And, of course, the left strongly wants that and the right strongly opposes it.

But what people here are calling a "strong public option" was never on the table. And you know why it wasn't on the table? Because of what I wrote in the previous paragraph. A public plan which was open for enrollment to all Americans and then which would have strong bargaining power with the health care providers would end up being, along with Medicare/Medicaid, a US government single-payer system. That would be probably the best possible outcome...but imagine how much a struggle it's been to get this much more watered down reform, how powerfully the interest groups opposed to reform have fought against what is not really that much of a threat against their interests compared to a single-payer system. Sadly, the "strong public option" that people here support and which they thought, for many months, was the core of the health reform being proposed never had a chance in Hell of even making it out of committee. The strongest public option out of committee was from the HELP committee, and it only because it included merely allowing the public plans the option of using its/their bargaining power to pay providers the same as Medicare rates. What it didn't include were universal enrollment, any sort of government subsidy that would allow it to charge consumers lower premiums, or any sort of guarantee that the public plans would charge consumers lower premiums.

The people here and elsewhere who have supported the public option have all along thought that it would be much cheaper than the premiums of the private companies, and pundits like Benen (but not Klein) have abetted that wrong belief. But there's nothing in any of these bills which would guarantee this—and the only reason to suspect it is because the public option won't have shareholders to reward. But in all the bills, it does have to basically break-even on premiums versus payments to providers. The difference between the profit margins required by the private plans and the lack of it in the public plans is not going to make that much of a different in premiums—ten percent, at most. People here are imaging that private exchanges for individuals will be $575 a month or something (which they won't) and so $500 is really that much better? From reading these comments, people have expected the public plan premiums to be a small fraction of the private plan premiums...and that's not going to happen, was never going to happen.

People object to continuing to pay money to private insurers and to have government subsidies to private insurers to make the premiums affordable to low-income people. Well, okay, I can see and somewhat agree to that ideological complaint. It's the same when the government provides food stamps so that people can buy food from large corporate grocery chains, or when Medicare pays corporate health providers, but we'll put that aside. Even if this is objectionable compared to a single-payer system which cuts out the insurance companies, there's still the simple realism that effectively eliminating the insurance companies wasn't on the table because it's just not possible. They're too powerful.

What this reform does is to greatly increase the regulation of the medical insurance industry in ways that protect the consumer—ways that eliminate many of the egregious practices that consumers have been rightly protesting. More to the point, it also guarantees insurance for almost all of the people who currently cannot get health insurance. If you've ever been one of those people, and needed it, you'd know how important that is and that being able to get health insurance at about the same rates as people get through their group policies via employers is a huge improvement over the status quo. People like me, people with chronic health conditions, cannot get any kind of insurance, at any price, when we aren't employed with someone who offers a group policy. That was a situation I was in throughout much of my twenties and early thirties. Don't make light of how much an improvement this will be for many Americans. It will eliminate this embarrassment of being an advanced nation with no universal health coverage.