Maybe giving up the sad remnant of the Public Option is a good idea, in some quarters.

But what Digby said yestereday also bears thinking about. What does it say about "progressives" that they roll over continually?

We really need to learn from the GOP: we don't fight nearly dirty enough, nor violently enough for what's decent and right, against forces that would destroy this country if given full rein to do so.

Bargaining Power

by digby

I may not be competent to weigh the importance of the various wonkish details of the health care reform package being debated in the Senate, but I'm pretty comfortable talking about this.

Ezra believes that if the votes aren't there for a decent public option then the horse trading should be around getting something good in return for giving up the public option rather than negotiating the terms of the public option. That would make sense if the public option were just another feature of the health care bill. But it is not. It is the central demand of the liberal base of the Democratic Party in this rube goldberg health care plan and has long since gone way beyond a policy to become a symbol.

Perhaps that is wrong on policy grounds. People will argue about that forever. But that doesn't change the fact that it is no longer a matter of policy but rather a matter of political power. And to that extent it cannot be "bargained away" for something like better subsidies, even if it made sense. "Bargaining away" the Public Option is also the bargaining away of liberal influence and strength.

Indeed, since the political establishment and the media have been declaring it dead for the past six months, the fact that it is still in the bill is a testament to liberal strength. And that is why Republicans and corporate centrists are so desperate to destroy anything that's called a "Public Option" no matter how many compromises are made to accomodate them. And it's why the liberals are so adamant about keeping it alive.

Again, as a matter of policy I don't know that the public option actually means much anymore. But as a matter of politics, it's very important. Powerful people, from outside and inside the Party are desperate that the liberals are not seen to win this battle. It changes the balance of power in ways that extend far beyond the health care debate and they know it.

Update: Bowers talks about the necessity of passing a final bill here, and a commenter uses this post to refute it. I don't actually think it does.

The "Public Option" is a symbol of liberal power, and losing it will be a serious loss. However, expecting that Democrats would vote against a final health care bill because it didn't have one was always dicey in my view. If, in the end this bill doesn't have a public option, I have little doubt that most pols are going to make a very serious gut check, as Bowers does, and ask themselves whether or not the public loss of this liberal power is worth tanking health care reform over. I don't know how that will come out.

What's really kept this symbol of liberal power alive is public opinion, in my view, rather than an institutional belief in the serious intention among progressives to tank the bill. It's the people who have the liberals' back on this one and that actually scares politicians. They aren't scared that liberal pols are going to vote against health care reform. They're scared of voters.

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digby 12/02/2009 12:30:00 PM Comments (56) | Trackback (1)

I would also like to give a more optimistic long-term scenario on this score, one that I have gone back and forth with. Proponents of the PO truly underestimate how difficult it will be to pull off well, no matter who is included. A bad PO would be worse than none. What happens if insurers can't reduce costs without a PO?

1. Inadequacy of "insurance only" intervention is inescapable -- no one can blame PO or anything else.

2. Medicare is still out there, for expansion.

In my oh so humble opinion, the most important things are to (1) assimilate universal coverage as "the norm" and (2) improve Medicare.

If health care providers and insurers cannot make a commercial solution "work" for the rest of us, an improved and more efficient Medicare will loom large in the eventual resolution of that problem.

Points taken, but the problem is that this deeply flawed bill will probably kill for the forseeable future any chance of making the urgently need reforms to keep our dysfunctional health care system from further distorting the function of our overall economy. The reason we can't make these changes at this point is because a substantial chunk of the population has deluded themselves into thinking the system is working OK for them, and Republithugs are frantically stoking people's natural fear of change to maintain the status quo for the people who the system is REALLY working for, i.e., their benefactors in big pharma, big insurance, etc. Unfortunately, the Dems are so invested in their image of themselves as victims that they have not found the ability or will to fight for what they know is right.

dcsusie,

Our system is dysfunctional, more so now than when Medicare was implementd, but even with that, people made the same claims about Medicare -- it was the end of democracy and civilization as we understood it. I don't know that this bill is as deeply dysfunctional as you suggest. There are things that could be tweaked to make it much better. At 40+ years, Medicare is still being tweaked and amended.

If things have come to the point where it is impossible to fix something after it has been passed, we are doomed. It doesn't matter how ideal the bill was from your perspective. This is simply not the kind of thing that will be "one and done" no matter how good the bill seems -- it will have unintended effects, or loopholes will emerge, and so on.

This is just brilliant.

"We want health care! Medicare for everyone!" "You can't have health care. But how about this nice public option?" "Well... OK OK fine." "Actually, you can't have a public option either. How about this delicious piece of toast instead?" "Well, I don't want to be unreasonable... OK, I can live with toast." "Oh, as it turns out, you can't have the toast either. But hey, it's just a piece of toast, no big, right?" "That's a good point." "So it's all right with you if we just kick you in the balls?" "Sure, that's fine."

Your American liberals in action.

Here is where digby loses me:

But it is not. It is the central demand of the liberal base of the Democratic Party in this rube goldberg health care plan and has long since gone way beyond a policy to become a symbol.

It is true progressives get rolled all the time. People who actually care are always at a disadvantage in negotiating with people who don't. It is not an option to not care -- at that point one ceases to be progressive. But that is really what digby is saying: that the symbolic value to the progressive movement takes priority over flesh and blood, people losing their house because of uninsured medical bills, people dying of undiagnosed or untreated conditions, people losing insurance due to recission or having claims denied due to bogus decisions about preexisting conditions.

When you have a house, a job, and enough disposable income for a computer and internet connection it is pretty easy to say "from where I sit policy purity is a great idea." I suspect it'd be a little harder to say it to the face of someone in pain and without insurance due to recission: "I could have gotten a bill that would have prevented this problem, but it didn't have a robust public option, so I opposed it."

something that helps at least some people, however imperfect, is better than nothing, even if it requires progressives to lose a symbol. we don't turn down anti-recission, anti-preexisting condition rules and heath care subsidies just because it represents only half a loaf. that may make me a poor Congressional negotiator. I'll find a way to live with myself knowing that people who needed the help got better health care than they have now.

Chris Bowers' netroots reputation is NOT as a strategic political thinker. He's like an engineer...very good at seeing what's in front of him, but he is slow on the big picture.

It took him this long to realize that killing the bill would be a complete political disaster?

Maybe he's learning from Mike Lux, the only reason to read OpenLeft.

If there is no public option in the final bill, even an emasculated one, then there will be no "social policy program" created that can get better over time.

A final bill with no PO will be a bill that does some good by creating a few new regulations, but it will end right there -- there will be nothing left to build on.

We need a revolution in our health care system, not a band-aid. (sorry for the pun)

So isn't the question this: is a bill with a few good reforms in it worth passing if it also locks us into a system controlled by the insurance companies, and that guarantees the drug companies obscene profits forever?

Also, the CBO scored the bill with a public option. The cost savings will look dramatically different without it. Those who say they will not vote for a bill with the PO in it ALSO say they won't vote for a bill that adds to the debt.

A robust public option is best for Americans, and also leads to a reduction in health care costs -- what's not to like . . . unless you are an insurance company.

the same logic that dictates that it's worthless to supprt the Public Option also dictates that it's pointless to support the Democratic Party.

It's pretty clear that attempting to work within this party has failed. So you win the Public Option fight. Good luck holding the house next year.

I know I'm sounding like a broken record, but the little details in this bill will matter.

Right now the bill prohibits insurance corporations from dropping policies of people who get sick and from denying coverage to people with preexisting conditions. But the bill ties fines to the Social Security act of 1965, which limits the fine to a total of $25K. With major surgery costing hundreds of thousands of dollars and lifetime care for debilitating conditions costing millions, the insurance corporations will have every incentive to continue business as usual. The fines will become nothing more than a business expense (probably tax deductible) that will get passed on to the rest of us.

And if progressive and moderate Democrats give up on a public option (and real competition), what will they be getting in return? Any sort of limits on the increase in premiums? Limits on deductibles? Guarantees that provider networks will have the capacity to care for the insured without months of waiting?

Or will working people be forced to pay for insurance and still won't have access to health care because they can't get to a doctor in their network and even if they could they can't afford to pay the deductible?

Ezra also noted that ".... This bill, when it's finished, is not going to be very good. But it's going to be a lot better than what we have, and almost more importantly, a lot easier to improve in the future."

The insurance corporations will be getting hundreds of billions of taxpayer dollars. After their CEOs pay themselves nice half-billion dollar bonuses, they'll still have plenty of money to spread around in campaign contributions (bribes) to stave off any improvements.

In fact, once the dust settles I expect to see another push to allow people to buy insurance from out of state, so we'll end up with a few states racing to the bottom in deregulation, just like we had with credit card "reform". We'll end up with all the insurance corporations incorporated in some nice red state with regulations that make paying insurance claims completely optional.

Of course you know it's what the opposition to the PO knew progressives would settle for to begin with...since they are the only ones with an apparent conscious that dominates over profiteering.

But get one thing straight...this is what we are "allowed" to have from the corporatocracy and clearly demonstrates just where our democracy stands at present...almost a complete hypocrisy.

Even you Mr. Benen have been justifying with every post that the PO is not that important and could be bargained away for the greater good...yet never once mentioning that it was the only way to get the gov. involved in the Private ins. industry which eventually would mandate fairness and cost control into HC coverage.

Reform has become "Exchange"...a bargaining chip...a trade off... which to save lives means we all "must" pay to the profiteers. Why...because they own most of congress and control the MSM.
The democratic world of President Rahm Obama bargained away the PO long ago for feathers in their caps. Progressives aren't fooled. But we are told to be happy because at least it's not McCain and we are saving lives. Who dealt those cards?

But this is precisely why Obama should have taken a page from the one thing the Bush administration was enormously successful at: Demand way more than you're going to ever possibly receive, and then negotiate down until you get what you wanted in the first place.

Instead, Obama made concessions before any proposals were made, let alone voted upon. Now we're left with the public option being the only real bargaining chip left despite having been wittled down to the point where keeping it may very well do more harm than good.

Will the Democratic Party's backbone ever regain prominence?

This confirms the thesis that healthcare should be turned over to the Mexican drug lords because they know to get things done.

I completely agree with Kiweagle, who filled in the other side of the coin of my prior post.

If caring as little about people and only about winning like the Republicans do is not an option for progressives, we'll have to find other ways to succeed -- better messaging and educating, smarter framing and procedural structuring from the outset. Our interest in good, functioning government and the people it serves will always be our weakness when the final chips are down; we have to find ways to head off lose-lose options in advance.

The country has been purchased, the bill of sale is complete, 1/5th of us will die. That's the bargain they have made so the republican's can have their mythical majority back. The democrats gave it to them.
What the bribe was that caused this to happen? Good question.

Does it matter? Is there realistically anything, short of the entire bill itself, that can be given up to overcome obstruction? I doubt it.

If the watered down public option is scraped, they'll just invent new demands.

I'm OK with moving forward without a public option, but only if certain conditions are met. I don't see how you can mandate caverage, and fine those who don't have it, if you are not going to offer them a low-cost alternative. So, no public option = no mandate.

At the end of the day, if congress can severely limit insurance companies' ability to deny coverage, needlessly hike up rates, and mandate that minimal medical procedures are covered, then it's not the worst thing in the world. I still believe that a public option would have significant benefits in cost savings, and in guaranteeing that the above items are instituted.

I am wondering how many of the big insurance companies are financed by the big banks we, the people, have bailed out -- AND WHICH WE ESSENTIALLY OWN. If the insurance companies ARE owned in part by the big banks, and thus owned in part by us, why not leverage that into a public option by way of that public ownership?

I know that's far-fetched, the insurance giants aren't in hock to the banks that much, and anyway the companies make enough off of us that they could pay off the banks' debts to the Treasury if it looked like the government was going to exercise any control through those banks, but it'd sure as hell give those insurance execs a much-needed shock. I'd love to see that!

Of course, actually doing this would be "socialism" and not "Americanism," but I, for one, could live with that. The government has enough of a finger in the pies of commerce that one more, especially one that helps people in trouble, would be welcomed.

Just a thought.

Ed

Who cares what's in the Senate bill. Paa anything right now and get into the joint committee.

Use the process to completely embarrass the GOP.

As for a talking point some Dem senator should turn to whoever the GOP fop is on MTP and say, "this guy does't care about Grandma or his mother. He certainly doesn't care about the people dying every day from lack of care. It's all about personal gain for himself. Can't you see that, Fluffyhead?"

No Steve, it institutes $5000 fines IF a regulatory board actually forced the company to pay. Thats it. It doesn't actually 'prevent' anything. It is a small fine, far less than most companies would lose if they actually had to cover these people.

I know you all want to pretend this bill does something, but it doesn't. These fines are too small, and the regulatory boards will never actually issue them. This is America, regulation doesn't work.

Bowers: "When faced with a choice between the status-quo and providing subsidies to make it easier for low-income people to purchase private health insurance, I choose the subsidies."

Except without competition from a Public Option and no lid on premiums and no cost containment, the proposed subsidies will quickly be swamped by rising premiums and we will be back to rising numbers of those who cannot afford insurance who will then be hit with penalties for lack of coverage.

DISASTER.

The problem, Bob, is precisely what Benen's been pointing out at the conclusion of pretty much every post he's ever written: If the GOP isn't - or made to be - embarrassed by their surreal record of failure and hypocrisy by now, what on earth would embarrass them?

In any sane world with a media that actually reports the facts and historical background of our daily news, they would have been laughed out of government by now instead of being lauded by the Sunday talk show circuit.

I never thought that the public option was necessary for regulating insurance malfeasance or for making insurance available to people who do not get it from their employers and cannot afford individual policies. The value and NECESSITY of the public option is to put cost control into the system. As Howard Dean said, without the public option you can get health insurance reform, but you can't get health care reform. And without cost control, the improvements in our health care system are not sustainable.

It's regrettable that nearly all of the public option's cost-control teeth have been pulled, but if you think that it's easier to improve a weak something than a nothing, then all you pragmatists should support the public-option-on-life-support.

If the public option goes, then the mandate must go as well. Passing the mandate without a reasonably strong public option to control costs is political suicide. Republicans will beat us with this club, and unlike many of their claims, it will have the added merit of being true. Democrats will deserve to lose seats if we make this tragic error.

social policy programs generally get better, rather than worse, over time

Sorry but name one. Unless by better you mean more expensive, corrupt and inneffective.

Look, the reason the Public Option is not negotiable to anyone but Chris Bower's pathetic, balless ass is that this bill is going to make all future reforms impossible. The money that it will pump into insurance industry coffers will make all future reforms impossible. The only thing that will ever be possible is to nibble around the edges.

If we don't get a government program now, we never will. That is why we think it's better to kill this bill than let it pass. You all disagree, and thats fine. Your lame promises of futre reform are not serious. There will be no future reform after the insurance industry uses mandate money to buy more politicians.

I think digby's analysis falls down a bit because of one central fact.

Progressives have an entirely different task than conservatives. We are trying to make new things happen. Conservatives are normally trying to keep things from happening or otherwise doing essentially passive or negative things like cutting taxes. This is much easier to do, and their tactics are much better suited to doing it. It's generally much easier to block change than to make change.

One of the few recent attempts by the right to change the status quo was the effort to privatize Social Security. Despite all the usual Republican tactics, and control of Congress after the 2004 election, this was a total failure. It's very difficult to change the status quo, and that is what we are trying to do right now.

What Mr. Klein and Mr. Bowers seem to miss is that the public option is vital to the success of HCR. Without it all that occurs is Medicare Part D on steroids; the insurance companies, with no reason to contain costs, won't.
Without cost containment the price of EVERYONE'S health care will continue to sky-rocket. Which will ensure that voters (Democrats as well as independents) will come out in 2010 - to vote AGAINST the Democrats! Any politician who fails to recognize that deserves exactly what will happen to them in November 2010.
A failure to pass any HCR, while large, would not be insurmountable. Democrats would have to work harder to garner votes by explaining exactly WHY HCR failed but, considering all the evidence on video of Republican intransigence, it shouldn't be that difficult. If they want to be members of Congress, there's no reason they shouldn't, you know, actually have to work for it.
Several posters have taken Digby to task for referring to the public option as a "symbol" of the strength of the progressives in the Democratic Party. Why? I can think of no better symbol for progressives than to favor a HCR bill that actually does what it says and isn't simply another way to funnel money to campaign contributors. When nearly 60% of US citizens, irrespective of party, support that "symbol", wouldn't Messrs. Klein and Bowers be better employed using their talents spotlighting the weaknesses of any Democrats in the House or Senate opposing the public option, rather than quietly accepting the gutting of HCR and declaring THAT a victory?
The latter is what spineless Republicans do; I expect more from Democrats.

Quite frankly, Mr. Benen, I could not possibly agree less. The public option is still a very popular measure, and we should fight for it.

The problem is that Reid is (I think purposefully) undermining that. What his caucus should do is put the strongest public option possible in the bill and force the right-wingers to work at obstructing it. Stop with this pussy not-really-filibustering filibuster stuff, make them actually do it. Force them to put themselves on the record as obstructing a very popular health care reform measure.

Win-win situation for us. If the bill passes, hey, the dream comes true. On the other hand, if they succeed at making health care reform fail, we have a hammer to smash them over the head with in the next election.

And don't give me Bowers' self-blaming nonsense. If we fight and lose, at least we did everything we could to reform health care. It won't be our fault that the poor still won't have health care, it will be the fault of the extremist right-wingers who killed the bill.

This would be so very *easy* if only we had real leaders who were committed to this. Reid, unfortunately, isn't that. I'm no longer sure about Obama either. Pelosi shows some promise here, but she can't do it alone.

But it could be done, if we just went all in.

No Public Option. No Bill.

Taking an f'in stand is pragmatic...And in these times neccessary. Why?

1. A robust public option makes for better policy.

2. The American public wants a public option and good governance.

F everything else.