Part of me wants to snarkily say "oh yeah, 'change we can believe in' yep."

But if one looks at the original Social Security legislation, which didn't cover workers in jobs traditionally filled by women and non-whites - which nowadays covers everybody and has for all the 50 years I have been familiar with it - and the original Medicare legislation, which also didn't provide the kind of coverage it does now, the argument can be made that these folks are right that it's not worth the effort to fight for something that's practically nothing. Get the idea in legislation, then modify in the future as has been done before.

It's probably easy for me to say, with my access to my nice government-run, single-payer excellent healthcare - known as the Veteran's Administration.

In order to save the public option they had to kill it?

but could it be expanded and improved in years to come? With absolutely no public option in the plan its a dead issue.

Like many others have pointed out with SS and medicare, they weren't much when first enacted, but were expanded.

A public option must be included.

The real fun comes when the Dems drop the public option, only to watch as so-called moderate Republicans (and Sens Nelson and Landrieux) find some other aspect of the bill that is a non-starter.

Anyone who thinks dropping the public option will guarantee 60 votes is delusional.

My understanding of the reconciliation process is that any submission needs to be a budgetary issue in order to be considered. Certainly the public option is in line with this requirement, moreso than the majority of the rest of the legislation. Since reconciliation can't be filibustered, wouldn't it make sense to drop a weak public option in the health care legislation in order to pass it, and incorporate a much more robust version of the public option later through the reconciliation process?

The anti-healthcare propaganda machine has even infiltrated this blog. Click on the silhouette of the woman behind bars, on the left side of this screen (you may have to scroll down) with the slightly scary headline, "JAIL FOR NO HEALTH INSURANCE?" and you'll see the half-truth and scrambled truth factory at work flipping factlets, factoids and arthritic hips into the air to make bullbleep hash out of the truth. For example:

"According to the non-partisan Congressional Budget Office, the House Democrat version of the President’s plan cuts Medicare for the elderly by $535 billion. With these staggering cuts in Medicare funding, referred to as 'reducing inefficiencies' by Washington politicians, the elderly will not be able to get treatments like hip replacements or bypass surgeries and the scarce medical resources will go to younger people with a longer remaining lifespan.... "

What can I say? Blogger, first flush thine own toilet.

Yours very crankily,
The New York Crank

Matt Yglesias didn't go quite so far as to say the provision is no longer worth pursuing, but he concluded that the remaining public option has been "defined down to something that's much less significant."

Matt has been telling us to give up on the public option since September, so this is hardly surprising.

Unless there is someway to get some of the goodies for the industry out of the bill, HCIR without the public option will be perceive by the pundits and public as a HUGE defeat for reform and the Democrats.

I don't see where getting this bill w/o the public option passed is much better politically than voting the package down. I also fail to see where ceding complete control of the Senate to the Nelsons, Landrieus, and Liebermans is a good thing.

OTOH, this tepid bill is probably still better than doing nothing and, as far as the situation goes, will be an improvement over the status quo.

I have no answer as to how I now feel about passage of this bill.

I wonder if the Rockefeller proposal in the Finance Committee of keeping insurance companies' medical loss ratio above 85% in order to participate in the exchanges wasn't an alternative way to insure good care and keep a pressure on premium costs.

If it's so measly and will do so little, then how does it have the superpowers its opponents ascribe to it? They're arguing that a public option will bankrupt the nation, destroy private health insurance companies and make us all into gay communists, even if it only covers 12 people in one town in nebraska.

Yes, the PO must be sacrificed so that the provisions liked by people who can always afford health insurance -- portability and end of rescission -- can be enacted.

I saw this coming a mile away, that health insurance reform would only end up serving the interests of the upper middle class. That Josh Marshall is advocating jettisoning the last real progressive promise of health care reform -- as impotent as it is -- so that he himself will be better off, is not a surprise.

The entire measure needs to be defeated.

Single Payer.

Now.

What's delusional is anyone posting here thinking that they know exactly how to get votes in the Senate. Like all the geniuses who think that Obama can "twist arms" with magical unilateral unstated incentives or punishments and Democrats could just "get tough", and ignore all the signals they get from the insane campaign finance system, and the small state bias of the Senate.

We will get incremental progress. We always do. Idealists need to deal with reality. Fight like the devil, get only part of what you want, and then dust yourself and begin the battle anew. That is politics.

Or, just whine on blogs forever.

Rep Grayson (d) FL strongly urged HReid change the number of senators needed for voting to 55 rather than 60 . This would stop the paralysis of the senate and move legislation along. This would stop the need for watering down the public option to satisfy Snowe and Leiberman and blue dogs. The insurance & pharmaceuticals companies, friends of both sides of the aisle will be very pleased that competition will be nil.Americans have yet again been skewered by Congress in a bipartisian way.

it's not hope and change anymore. (yeah right just 10 mos in, sorry... but if you dont see the trends everywhere as to what this admin.is made of, 2 words: eye doctor)

i'd say the obama admin. is

"no bang, all whimper..."

When will we get anywhere with public insurance if not now?

This was all entirely predictable. There was never any chance of any kind of public option passing. Are you kidding? There are too many Democrats as deeply into corporate pockets as the Republicans. They are merely using Republican obstructionism as cover to protect the industries which pay to keep them in office.

I think the Democratic party will be lucky to get 25% of registered members to vote in 2010.

The more I read of Starr's OpEd, the more it sounded like, "Don't worry about passing or improving a public option. Instead, strengthen the exchanges to the point that it's a really, really robust public option." In other words, if you can't get a public option passed, try something even harder?

Well if they give it up, let's hope the Dems don't do it unilaterally. Let's hope they get something for it. (Which they probably won't.)

But the Public Option is about the principle of the thing. Once it's established, no matter how weak, it can then be strengthened over time.

Rep Grayson (d) FL strongly urged HReid change the number of senators needed for voting to 55 rather than 60 .

Harry Reid can't do this. The Senate needs to vote on it and aside from the difficulties of changing the rules in the middle of a session, Senators are very reluctant to make these kinds of major procedural changes in general. This would essentially be a slightly less nuclear version of the so-called nuclear option and it is not at all a sure thing that there are anywhere near the number of votes to make it happen.

As for whether fighting for the public option is worth it, I would say yes. I agree that it is extremely weakened but I would hope it still has some value as at least some sort of bargaining chip. If we have to give it up, I would hope that we might get better subsidies or a more progressive tax scheme to pay for the bill. But giving it up, just to please a weasel like Lieberman, who will then begin working on torpedoing other elements of the bill, seems premature and ill advised.

Bloggers spend months insisting the public option is the most important thing about the bill, then when they finally get it decide it didn't matter after all. What were you fighting for, then?

I don't understand what's so "measly" about the public option as it stands. It's as strong as it's ever been. The Senate version of the public option has had the "negotiated rates" provision for months. The element that the public option, like the exchanges, is exclusively a new option available only to some people, specifically to those groups currently tending to lack insurance, has been present even longer-- and is also the easiest element of the bill to fix, since it repairs itself if the Wyden amendment passes. The opt-out is nothing. Nobody cared about all these myriad defects until Reid finally showed the spine everyone was screaming for him to show-- and then all of a sudden the blogs got wobbly-kneed, either deciding like Marshall did that getting to 60 was too hard and we should just go pragmatic and pass the thing already, or suddenly deciding the entire bill was a sell-out from the beginning damn you larry summers the democrats deserve to lose in 2010 for this betrayal etc.

Progressives have no idea what they want. If you follow the blogosphere everything that happens is outrageous and offensive, but nobody can identify what better thing it is they want instead. People do occasionally call for positive action but if an opportunity to make that progressive policy item real ever presents itself it's all of a sudden boring. How can you expect Washington to start doing what you want if you can't even decide what that is?

for those conservative whiners on here who don't get it, I'll explain. the public option, as is, is a shadow of the idea we were sold on during the 2008 campaign most importantly in that practically no one is eligible for it. the idea was supposed to be that it was a non-profit administered by the government which wouldn't spend nearly as much on admin costs, and would spend no $ on PR and marketing, which anyone who wanted to sign up for, could. this would have created a huge plan with massive bargaining power able to drive down costs, able to bargain on drug prices, with rates tied to Medicare reimbursement rates plus 5% or something along those lines. this is NOT what is on the table now. what we have now would have 1) no bargaining power to lower drug costs as per Obama's deal with the Pharma companies, 2) a very small pool since nobody who has employer-provided insurance would be eligible (which is the vast majority of the population) and 3) negotiated rates instead of rates tied to Medicare reimbursement rates.

it would still be good to pass the bill with the public option, and it could be improved and expanded in the future. but as it is, it pretty much sucks and has been gutted to the point where it is basically designed to fail, or worse - absorb the 'undesirables' that other companies don't want to cover due to illness, genetic predispositions, pre-existing conditions, etc.

But the Public Option is about the principle of the thing. Once it's established, no matter how weak, it can then be strengthened over time.

This is it. You have to wonder if the public option is so lame, why do we have Democratic senators who will threaten to kill the entire bill over it.

Bloggers spend months insisting the public option is the most important thing about the bill, then when they finally get it decide it didn't matter after all. What were you fighting for, then?

Gee, if you pretend all bloggers are part of a group-mind with one opinion, you sure can make them sound incoherent. Or you could just recognize the reality that different progressive bloggers have different points of view, and there has always been a group that thought emphasizing the public option was a mistake, and a group that thought exchanges without a public option were a mistake.

As has already been pointed out, Matt Yglesias was in favor of dropping the public option in September, and Josh Marshall has always been lukewarm on the public option as well. This isn't the first time this has happened in this fight, and I suspect it means that those on Capitol Hill who want it dropped will use this as another excuse to do so, and in response we'll get another round of grassroots pressure in favor of the public option.

The essential problem is this: exchanges may be able to drive cost control and better service, but only wonks will be able to tell if they have been constructed to do so. Consequently, many of the arguments in favor of exchanges as the main thing that matters bear a striking resemblance to the arguments in favor of the Iraq War "if they do it right."

In contrast, public-insurance programs are reasonably understandable, and even if the initial program is weak, it opens up the possibility that it can become what we really want. (And if you think that doesn't work politically, look at how easily Republicans are able to sell their base on tax cuts for the rich because they all dream of being rich some day.)

I don't understand what's so "measly" about the public option as it stands. It's as strong as it's ever been.

This is, for the most part, true. I mean that it has been a bit more watered down recently but you are right it is about as strong as it as has always been in theory, which is to say it has always been very weak. Yes, the left leaning blogosphere has been strongly focused on this since the beginning but they remain so now. The people who are expressing skepticism now, have been doing so all along for the most part. The only difference is that now, more cards are on the table. The conservadems have shown their hand and we are largely past all the hypotheticals, which is to say, we have something like a late draft of what HCR and the PO are actually going to be. The questions are, given what we now know the PO will be, can we get to 60 with it and is it worth risking not getting to 60?

I think progressives got it wrong believing 'triggers' would never be pulled.

I would have rather had a hard trigger and a better public option. I think that is why there was that flurry of stories from the Obama administration that they wanted Reid to go with the trigger, not the public option as a path to 60 votes. The clock on the trigger could have started with one year after passage and no time would have been lost in terms of implementation of the public option. I don't know what can be salvaged now but it's clear Harry Reid can't count votes for squat and should be replaced.

People are too flip with the 'It's three dimensional chess!' dismissals of legislation. Simply pulling in your ideological direction isn't two-dimesional chess, it isn't even checkers. Politics is a lot more complicated than stamping your feet and smugly citing the Overton window. Knowing clean breaking points in the debate that leave tidy bits of legislation behind instead of a diluted mess is required and I'm not sure Harry Reid or those trying to pull 'Centrist' Dems left ever got that.

I want a new politics that isn't simply Joe Lieberman vs. the world but there is a path dependence from using things like the 'progressive block' strategy and Lakoff strategies that leave you in the same place again and again and it's not a good place with the rules of the Senate.

Howie sez:"OTOH, this tepid bill is probably still better than doing nothing and, as far as the situation goes, will be an improvement over the status quo. "

The consensus is that, once passed, we can improve it, later. I dunno. The Left is beginning to raise their voices, too. A group favoring single payer (Medicare for all at 55, dropping to 45 in later years, etc) is talking about Sen Bernie Sanders voting against the bill, thus killing it.

Consider a continuation of the status quo: 45,000 deaths year, healthcare bankruptcies, and a growing number of the uninsured. None of those people see their own misery as a partisan issue, despite the Republican dollars being spent.

Maybe a wholesale slaughter of incumbents in 2010 would galvanize the remainder to do it right, second time around. . .

The entire measure needs to be defeated.

Single Payer.

Now.

Yes, passing single payer will certainly be easier than passing a milquetoast version of a public option.

1. Kill the measure.
2. ????
3. Single payer!!!!

God damn, you're stupid.

The questions are, given what we now know the PO will be, can we get to 60 with it and is it worth risking not getting to 60?

Well, the third question, as you note in your previous post, is whether dropping it will get us to 60 when tools like Lieberman will just move on to the next "unacceptable" portion of the bill.

the only argument left is the camel's nose under the tent argument. If what is left of the P.O. accomplishes that, then its well worth it providing a platform to incrementally march to single payer. If it can't even do that and does indeed become the repository for the uninsurable, then it should be jettisoned.

if they come to believe that what's left of the measure is hardly worth fighting for, and reform proponents fear that the remaining public option won't be effective, they'll invest their energies elsewhere.

As well they should. The strong attachment to the (relatively weak) public option is largely sentimental; people who really want a single-payer system (which would be great, but ain't gonna happen) cling to it as the last vestige of their dream.

The reality is that either expanding access to the exchanges or increasing the subsidies (or better yet, both) would have a much more positive impact on more people than the public option. Trading the public option for wider access to the exchanges and/or bigger subsidies would be a smart deal, and result in a better bill.

But as attention turned to the end game, and the public option emerged as arguably the biggest hurdle to overcoming Republican obstructionism

Republican obstructionism? Republicans are going to engage in obstructionism whether the public option is present or not -- drop it, and the GOP will just latch onto another bogus issue.

The status of the public option is a problem among so-called "blue dog" Democrats, and its final status might influence the way Olympia Snowe votes, but that's it.

Let's not pretend Republican obstructionism is based on good-faith opposition to one provision.

Then we've lost what will turn out to be the real saving grace of a reform bill. Once again Steve...and maybe you'll notice and help pull Josh Marshall's head out of his ass on this:

THE BIGGEST REASON FOR INCLUDING A PUBLIC OPTION NO MATTER HOW WATERED DOWN IS THAT IT OPENED THE DOOR TO GOV. INVOLVEMENT IN THE HEALTH CARE INS. INDUSTRY WHICH COULD HAVE BEEN EXPANDED ON LATER.

Without it private ins is laughing all the way to the bank and Rahm Obama gets what they sought to begin with since it already bargained away the PO for campaign donations and that is the "reform" bill is now an "exchange" bill.

Private ins. has exchanged pre-existing conditions, caps etc for millions of new customers many heavily subsidized by tax dollars. But then we'll take anything to save 45,000 lives/yr huh...but don't call it a "reform" bill when without a PO it is really an "exchange" bill with private ins (just like big pharma) getting most of the benefits.(Like making murderous thieves cross their hearts and hope to die if they aren't fair)

Corporatocracy 5.....Democracy 1.(forcing lobbyists off of advisory boards)

TC in LA: Your VA health care isn't of course just single payer, but is British National Health Service style healthcare.

Yeah, I'm stupid, voted for real change.

But I'm done voting for that and voting for Dems.

Fuck them.

Reading all of the posted comments regarding the "Public Option" I can see why the reporters can't even write their own columns without taking ideas from other columnists. I feel that all of the reporters would love to see Obama fail with trying to pass the Health Care Reform that includes the Public Option. What a great story that would make. Various readers that posted the comments that the Public Option only leads to the government take over are living in never never land. I don't think that the reporters or alot of your readers even know what the Public Option is. The Public Option is just another health care plan to choose from. The Government would not be responsible for paying the premiums. Why should we worry about the deficit, after all the Bush Administration and the GOP let the wars and Medicare Part D go unfunded. What ever Bush wanted the GOP rammed it through.

And what are we left with - mandatory health insurance.

Don't buy health insurance & face a hefty fine or go to jail.

What a fucking mess.

And don't forget this first bill does not have to be the be-all and end-all, as we always go about this sort of thing with successive bills.