Thursday, August 20, 2009
MAYBE THE White House meant to signal that it was backing away from its commitment to a "public option" as part of new health insurance exchanges. Or maybe the hedging words of administration officials were over-interpreted on an otherwise sleepy Sunday morning in August. It doesn't much matter, because, either way, the reality is that, if the Obama administration wants to get health reform done, it's going to have to back away from the public option sooner or later -- and it's getting awfully late.
This is not a matter of ideology but of political nose-counting. The kind of comprehensive health reform that the president rightly wants -- changes that would extend affordable coverage to millions of people and help slow the growth of health-care costs -- requires 60 votes in the Senate. Democrats could muscle through some provisions with 50 votes, but a Senate rule limits how much can be done through that route. Measures such as establishing insurance exchanges or imposing new coverage requirements on insurance companies, as President Obama has been emphasizing, might be vulnerable to being stricken. And there's no way to amass 60 votes with a public option in the bill.
To listen to some Democrats talk, reform without a public option is scarcely worth doing. This is crazy. Rep. Eddie Bernice Johnson (D-Tex.) has asserted that "without the public option, we'll have the same number of people uninsured. If the insurance companies wanted to insure these people now, they'd be insured." But under the proposed reforms, even without a public option, insurance companies would have to agree to cover people regardless of their health status. The government would extend Medicaid coverage to millions and provide subsidies so that millions more could purchase insurance. Mr. Obama was right when he described the public option as "just one sliver" of the overall proposal.
The Post's Michael D. Shear and Ceci Connolly report that the president's advisers have been taken aback by the ferocity with which the left is opposing dropping the public option. That seems hard to believe. We wrote back in April that the left's "fixation on a public plan is bizarre and counterproductive." If anything, the administration fanned the flames of this irrationality with its repeated statements about the importance of the public plan. Now it is paying the price.
There's blame to go around, and there will be even more if reform fails, but the most disappointing performance has come from Republicans who sense a political opportunity and seem unwilling to accept any proffered compromise. It's ridiculous to describe the proposed nonprofit cooperatives a "Trojan horse" public plan, in the words of Sen. Jon Kyl (R-Ariz.), the minority whip. Whether these cooperatives would add much to the mix is a reasonable question; equating them with a public plan that could dictate Medicare-based rates to providers is nonsense. Republicans are enjoying August more than their Democratic colleagues, but they risk overplaying their hand.