By E.J. Dionne Jr.
Thursday, October 1, 2009
The strangest aspect of the debate over a public option for health coverage is that the centrists who oppose it should love it.
It doesn't involve a government takeover of the health-care system. The idea is that only consumers who want to enroll in a government-run health plan would do so. Anyone who preferred private insurance could get it.
The public option also uses government exactly as advocates of market economics say it should be deployed: not as a controlling entity but as a nudge toward greater competition. Fans of the market rightly oppose monopolies. But in many places, a small number of insurance companies -- sometimes only one -- dominates the market. The public option is a monopoly-buster.
Centrists tell us they want to hold down spending and fight deficits. Strong versions of the public option, as the Congressional Budget Office showed in its scoring of Sen. Jay Rockefeller's proposal, cut the costs of insuring everyone.
Unfortunately, the debate over the public option has rarely concentrated on the substance of the idea. Instead, it has been almost entirely ideological.
Because opponents know from polling that the public wants the chance to choose a government plan, they move the discourse to abstract and often demagogic ground. The most revealing "argument" during the Senate Finance Committee's public-option debate on Tuesday came from Sen. Chuck Grassley.
"The government is not a fair competitor," Grassley said. "It's a predator."
Grassley was then forced to explain how he felt about Medicare. Is it predatory for government to pay health bills for the elderly? Is Social Security, which lives side by side with private pension and savings plans, predatory? Is it predatory for government to regulate, well, predatory lenders or stock swindlers or bank boodlers?
Democrats have been far too timid in taking on the right wing's arguments against government. They have been defensive when they should be going on offense by insisting that government can expand human freedom and give people options they would not otherwise have.
Consider universal K-12 education, loans and grants to help students attend college, clean water systems, and unemployment compensation so people can get by while they look for the next job. A public insurance option lies squarely within this American tradition of using government to open new avenues of choice and opportunity.
The public option was voted down in the Finance Committee -- 15 to 8 on Rockefeller's strong version and 13 to 10 on Sen. Charles E. Schumer's compromise version. Sen. Max Baucus, the Finance Committee chairman, was in the odd position of saying that the public option was dandy ("There's a lot to like about a public option," he declared) but twice voting no because he believed too many other senators would vote no. I guess that's how leadership works in the Senate.
Yet supporters of the option and the Obama administration have made unforced errors of their own that led us to Tuesday's votes.
The public option is a means to an end, not simply the symbol it has become in some progressive circles. From the beginning, the public option should have been seen as part of a larger effort to make insurance affordable. This means that its promoters need to worry more than they have so far about subsidies for the uninsured. If this bill does not help make insurance affordable for middle-income families, it will be a failure.
As for the Obama administration, it's been too ready to hint that it would throw the option overboard. Its highly public unfaithfulness to the view it purported to hold simultaneously enraged progressives and weakened its bargaining position.
Schumer and Rockefeller were right to insist that this week's votes will not end the battle for the public option. Its final form will be subject to negotiation and might involve a "trigger" to bring it into being in uncompetitive markets -- as long as the trigger is not a meaningless sop. But the fight is worth waging to keep the issues of competition and affordability at the top of congressional minds.
And one more pragmatic consideration: Americans wonder whether all this noise around health care will do anything to change their lives. By offering a genuinely new insurance product, the government would be acting as an innovator, a prod for change and, to borrow a phrase, an insurer we could believe in. As Max Baucus has taught us, there's a lot to like about that.