Time For Obama To Step Up On Public Option?

Brian Beutler:

Last week, at a meeting between Senate health care principals and Obama administration officials, the White House basically told Senate Majority Leader Harry Reid it would be leaving most of the big legislative decisions on reform to him. [. . . ] In a sign that Reid may be willing to acquiesce, if only the White House helps him whip the caucus into shape, a top Capitol Hill aide tells me "Right now, we don't have 60 Democratic Senators in lockstep with one another on the public option...we need the president to send a strong signal to those in the room negotiating the merger, that the public option is, really, what he wants in the final bill."

(Emphasis supplied.) It's amazing that this would need to be said. But what people do not want to accept is this - President Obama is indifferent to whether the public option is in or out of the health care reform bill. He is fine if it is in. And he is fine if it is out. In the debate on the public option, President Obama is content to be the Bystander President. Time to accept this and act accordingly. In that sense, focusing on Reid makes sense. He is up for reelection next year. And there is one thing pols are not indifferent about - getting reelected.

Speaking for me only

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    Obama being indifferent is not okay. (5.00 / 5) (#4)
    by inclusiveheart on Tue Oct 20, 2009 at 07:58:27 AM EST
    As far as I am concerned, that means that he is basically useless. Wasted space that sucks up too much important air in the room.  Healthcare is an easy one really - that is if all those pretty speeches he made during the campaign actually meant anything at all to him.  

    Hey man, give Obama a break (5.00 / 3) (#14)
    by MO Blue on Tue Oct 20, 2009 at 08:58:58 AM EST
    He has important things to do like photo ops, speeches and funding raising. Prioritizing his time is important. Can't expect him to waste his time on something as trivial as influencing HCR.

    And parent teacher conferences. (none / 0) (#31)
    by oculus on Tue Oct 20, 2009 at 10:48:38 AM EST
    I did not say it was ok (none / 0) (#5)
    by Big Tent Democrat on Tue Oct 20, 2009 at 08:24:04 AM EST
    I said it IS.

    Didn't get the impression that you (5.00 / 1) (#9)
    by inclusiveheart on Tue Oct 20, 2009 at 08:38:34 AM EST
    were saying that it was okay.  Just making the point that it is not okay how this has gone and how he has handled himself.

    That's what doesn't make any sense to me.  His lack of effort on HCR is gonna bite him on the a$$ come the next election

    I was happy to read (5.00 / 1) (#10)
    by lilburro on Tue Oct 20, 2009 at 08:46:48 AM EST
    Baucus taking a slightly friendlier tack to the PO yesterday.

    But yeah, it's as simple as arm-twisting.  No matter how popular Obama is he still has a well-oiled electoral machine that some Senators surely envy.  I think he should have plenty of leverage on the few Senators who are not part of the 52 PO supporters.

    And this is funny.  I guess Booman now agrees that the President is the weakest branch of government:

    The Senate will seek to pass a strong bill, but will settle for something weaker if that will secure passage. The House is the place to look for capitulation. If the public option gets watered down in the House, that's a sure sign that a few centrists in the Senate have successfully blackmailed the rest of the Caucus, the president, and the American people.

    Not much of a chess player if you can be "successfully blackmailed" by a "few Centrists in the Senate."

    Another "The President is Powerless" (5.00 / 5) (#20)
    by MO Blue on Tue Oct 20, 2009 at 09:42:42 AM EST
    post by Booman.

    Funny how a complete idiot like Bush had power to move his agenda and Obama, the greatest most intelligent (etc.) president the world has ever seen, is completely powerless.

    Must be painful to keep twisting yourself in knots to come up with logic like that.  


    There are many ways to numb that pain :) (none / 0) (#48)
    by Militarytracy on Tue Oct 20, 2009 at 04:16:42 PM EST
    Obama is not indifferent about mandates (5.00 / 3) (#18)
    by NealB on Tue Oct 20, 2009 at 09:31:38 AM EST
    Obama is not indifferent about forcing 30 million new customers into the insurance system. He believes that the infusion of so many fresh bodies into the system will radically change it for the better. He cares about the talking point: "30 million Americans that never had health insurance before will have it starting in 2012."

    Gotta have those talking points! (5.00 / 2) (#28)
    by Fabian on Tue Oct 20, 2009 at 10:37:21 AM EST
    Talking points are important!

    I got it slightly wrong (none / 0) (#53)
    by NealB on Wed Oct 21, 2009 at 08:44:12 AM EST
    The exact talking point appears to be this:

    "The bill you least like would provide 29 million Americans with health care. "

    - Obama in his OFA rally, evening of 10/20/2009


    Obama's political strategy (5.00 / 11) (#19)
    by MO Blue on Tue Oct 20, 2009 at 09:34:18 AM EST
    parody below

    Can't blame me. I didn't do anything. I even said I liked the idea of a public option.

    During my campaign I always said that together WE could achieve our goals.  I never said "I" will do this or that, it was always "we".  If you aren't getting what you want, then you didn't work hard enough. Did I mention that I gave speeches saying I liked the idea of a public option.


    Dear Harry Reid, (5.00 / 2) (#30)
    by MO Blue on Tue Oct 20, 2009 at 10:47:21 AM EST
    How do you like the president hanging you out to dry on the public option? Pretty powerful ads running in Nevada tying you to the success or failure of the public option, huh. Whether you like it or not you have been designated as the "killer of the public option" if it is not in the Senate bill. Somehow I don't think that designation will help your chances of reelection.

    Has President Obama promised you a cabinet position for taking one for the team or do you have a job lined up to lobby for the insurance industry? Seems like you should get something for being the villain in this game of "hot potato."


    True, our real leverage is with Reid (5.00 / 1) (#33)
    by ruffian on Tue Oct 20, 2009 at 11:04:35 AM EST
    at this point.

    Kind of expected some heat from the top down for something this important, but it is what it is. I see why Obama wanted to do HCR now instead of the year before his own primary year. Profiles in Courage.

    steppin' up, O-style (5.00 / 5) (#38)
    by Illiope on Tue Oct 20, 2009 at 11:53:34 AM EST
    sorry folks, Obama has other CRUCIAL issues at hand:

    President Obama is hosting a swanky fundraiser at the Mandarin Oriental in New York tonight -- and about a third of the 200 Democratic donors attending will be from Wall Street. Each donor is paying the legal maximum of $30,400.

    don't forget: people support obama, not the other way around.

    status quObama rules the land.

    That's obscene. (5.00 / 4) (#44)
    by nycstray on Tue Oct 20, 2009 at 02:22:37 PM EST

    OMG WTF!?!? (5.00 / 2) (#45)
    by Militarytracy on Tue Oct 20, 2009 at 02:26:07 PM EST
    What a total loser in my book now!

    obama's new base (5.00 / 4) (#46)
    by kmblue on Tue Oct 20, 2009 at 03:01:34 PM EST
    "the haves, and the have-mores"

    see: George W. Bush


    The poor, poor investment community (5.00 / 3) (#47)
    by MO Blue on Tue Oct 20, 2009 at 03:22:36 PM EST
    Dr. Daniel E. Fass, another chairman of the event who lives surrounded by financiers in Greenwich, Conn., said: "The investment community feels very put-upon. They feel there is no reason why they shouldn't earn $1 million to $200 million a year, and they don't want to be held responsible for the global financial meltdown." Dr. Fass added, "How much that will be reflected in their support for the president remains to be seen." link

    I guess they didn't make any of the decisions that lead to the global financial meltdown either. Strange how all these things just happen without anyone being responsible for the outcomes.


    He pulled the same thing (5.00 / 1) (#49)
    by Spamlet on Tue Oct 20, 2009 at 04:30:01 PM EST
    in San Francisco last weekend.

    How about getting Roland Burris (none / 0) (#1)
    by andgarden on Tue Oct 20, 2009 at 07:47:11 AM EST
    to say that he won't vote for cloture on any bill without a public option?

    Counting on Roland Burris (none / 0) (#2)
    by Big Tent Democrat on Tue Oct 20, 2009 at 07:51:18 AM EST
    is not an option imo.

    Well, no, not count on (none / 0) (#3)
    by andgarden on Tue Oct 20, 2009 at 07:58:18 AM EST
    But to direct the debate; to limit the President's options to a) promoting the public option, or b) getting no bill.

    That;'s counting on Burris too (5.00 / 1) (#6)
    by Big Tent Democrat on Tue Oct 20, 2009 at 08:24:30 AM EST
    Burris (none / 0) (#24)
    by mmc9431 on Tue Oct 20, 2009 at 10:03:01 AM EST
    I'm not sure Burris would buck Obama. He might since he's really just keeping the seat warm. Here is part of an e-mail I received from Burris:

    I believe Illinoisans deserve better. That's why we need a public option as part of our health care plan. It's time to restore choice and accountability to the insurance market.

    A public option would save billions of dollars a year, stop companies from denying coverage to those who need it most, and reduce the burden on American businesses and families. This would improve health outcomes and make quality care more affordable for everyone.


    In a related note: (none / 0) (#7)
    by Wile ECoyote on Tue Oct 20, 2009 at 08:29:52 AM EST
    3,000 NHS staff get private care

    THE National Health Service has spent £1.5m paying for hundreds of its staff to have private health treatment so they can leapfrog their own waiting lists.

    More than 3,000 staff, including doctors and nurses, have gone private at the taxpayers' expense in the past three years because the queues at the clinics and hospitals where they work are too long.

    NHS has existed for decades (none / 0) (#8)
    by Big Tent Democrat on Tue Oct 20, 2009 at 08:37:57 AM EST
    "The number of health service employees sent to private healthcare facilities has more than doubled in the past three years.

    In 2006-7, 708 staff working for NHS trusts received private treatment at a cost of £279,000. Last year it increased to 1,641 at a cost of £828,413."

    Sounds like an underfunding problem to me.


    Thats (none / 0) (#15)
    by Wile ECoyote on Tue Oct 20, 2009 at 09:13:49 AM EST
    what they need in Britain, higher taxes.

    Perhaps less spending on defense (5.00 / 2) (#22)
    by Big Tent Democrat on Tue Oct 20, 2009 at 09:58:02 AM EST
    makes more sense.

    Heh (none / 0) (#26)
    by Wile ECoyote on Tue Oct 20, 2009 at 10:10:41 AM EST
    I'll lay money private healthcare is part of the deal for the gov't providers.  

    This is practically a rounding error, (none / 0) (#32)
    by HenryFTP on Tue Oct 20, 2009 at 10:57:05 AM EST
    given that the British spent £86,400,000,000 on the NHS in England in 2007-08:


    I'm having trouble finding a better source for it, but as best I can tell the NHS spent £1.5 billion in 2007-08 on private treatments for its patients (the payments to the private providers were guaranteed even if they didn't have full take-up of the capacity -- that could be a good clue as to why the NHS was willing to send some of its own employees to private health providers, given that the care was prepaid and the services underutilized):


    So I think this vignette needs to be viewed in context -- the NHS has problems but sending a few of its staff out for private treatment at £504 a pop is not a sign of the apocalypse, not when they were talking about leaving £220 million of the taxpayers' money on the table because the prepaid private care was not used.


    You know about this (none / 0) (#35)
    by Big Tent Democrat on Tue Oct 20, 2009 at 11:34:39 AM EST
    I do not. Just sparring a little with Wile.

    He is the Present President (none / 0) (#11)
    by jes on Tue Oct 20, 2009 at 08:51:04 AM EST
    I'm actually feeling sorry for Harry.

    Nope. This is an opportunity to (5.00 / 2) (#36)
    by oldpro on Tue Oct 20, 2009 at 11:39:09 AM EST
    shine.  LBJ would have reveled in it.

    Alas (5.00 / 1) (#40)
    by sj on Tue Oct 20, 2009 at 12:15:05 PM EST
    Reid is no LBJ

    But maybe Nancy is... (5.00 / 1) (#41)
    by oldpro on Tue Oct 20, 2009 at 12:20:49 PM EST
    I'm just sayin'...never underestimate a mom.

    A mom in the driver's seat?

    Could be awesome.


    A mom in the driver's seat (5.00 / 1) (#50)
    by Spamlet on Tue Oct 20, 2009 at 04:31:53 PM EST
    Nancy: "Don't make me pull this car over."

    Exactly. (none / 0) (#52)
    by oldpro on Tue Oct 20, 2009 at 08:13:45 PM EST
    Pedal to the metal, so fasten your seatbelts.  (Think Bette Davis in All About Eve).

    Obama's stand (none / 0) (#12)
    by jeffcrafter on Tue Oct 20, 2009 at 08:55:12 AM EST
      The trouble with our president, although one of the great orators of our time, is his inability to take a hard line. This being what it is, and the deaf ear of congress to the will of the people, I believe that what we get will be a watered down shadow of a bill.
      This said, I wish to make it clear that I think the plan must be made now as to how to make a round two bill, after the lawmakers have seen their future on failure. We have too important a bill to just let it go. I believe we can make enough noise after they fail to make them come back and do it right.

    No bill is better than a bad bill... (5.00 / 6) (#16)
    by lambert on Tue Oct 20, 2009 at 09:20:43 AM EST
    ... if the bad bill includes a mandate and, of the many public options on offer, the one selected is the p*ssant variety that only covers 9 or 10 million and is firewalled to those who have employer-based insurance now.

    And since that's the mainstream position now, we all get forced to buy junk insurance and there will be no savings because the government doesn't have enough leverage over the insurance companies and Big Pharma.  

    Personally, I think a legislative FAIL now (that is, no bill) would get the Dem's attention, if such a thing is possible, a lot more effectively than a policy FAIL later, at some point after 2013.


    On This American Life on public radio (5.00 / 4) (#25)
    by oculus on Tue Oct 20, 2009 at 10:07:47 AM EST
    this weekend the point was stressed that a small market insurer has no power to negotiate with hospitals and doctors and pharma.  Which sounds like what will happen with a restricted access public option, even if the bill permmitted the public option to negotiate.

    Plus, the insurance companies are regional... (none / 0) (#42)
    by lambert on Tue Oct 20, 2009 at 12:52:30 PM EST
    ... monopolies by now, and so the barriers to entry are huge.

    So, co-ops FAIL, at a minimum, and I would argue health exchanges, too. Not enough market clout.

    Translation: You can't buff a t*rd.


    I don't think Obama (5.00 / 4) (#51)
    by Spamlet on Tue Oct 20, 2009 at 04:35:24 PM EST
    is "one of the great orators" of "our" or any other time. When the TelePrompTer isn't jammed, Obama sounds slick, scripted, and faux-preacherly, like the corporate product he is. Granted, he sounds downright eloquent after George W. Bush.

    What kind of public option? (none / 0) (#13)
    by BobTinKY on Tue Oct 20, 2009 at 08:55:27 AM EST
    According to today's Washington Post poll, ". . . 76 percent [approve a public option] if it's limited to those who can't get affordable private insurance."

    76% support having Uncle Sam used SOLELY to provide coverage for those whose health issues make private insurance unaffordable.  Private insurers in the meantime sign up millions of healthy folks required by law to buy their product. That's whacked. My support for the public option goes away if it is based on affordability.

    What prevents private insurers from raising the premiums of those with health issues, or who in the future develop health issues (and I believe that would be all of us), to unaffordable levels?  At that point do these unfortunate individuals move to the "public option?"   Is the option in effect exercised by the development of a health problem your private insurer does not want to be on the hook for?

    A public option for everyone and anyone who wants it makes sense. Alternatively, provisions outlawing discrimination in the price of monthly premiums. Affordability requirements for a public option are nothing but a huge subsidy for the private insurance industry. It enables private insurers to move their "high risk" customers to Uncle Sam simply by raising monthly premiums to no longer affordable levels.

    Bait and switch, the polls, and public option (5.00 / 7) (#17)
    by lambert on Tue Oct 20, 2009 at 09:31:17 AM EST
    The American people think that the so-called public option will be like Medicare, available to all, but they'll be disappointed. (In other words, the bait and switch operation that the "progressive" advocates of public option successfully performed has infected the polling. Yay.)

    And note, please that:

    A public option for everyone and anyone who wants it makes sense.

    is exactly what is not on offer. (That was the bait. We're in switch mode now, with public option being sold as Medicare like, and now covering 10 million or so, and firewalled from those who already have employer-based insurance; in other words, if you don't like your insurance, you could still be forced to keep it.)


    I understand (none / 0) (#21)
    by BackFromOhio on Tue Oct 20, 2009 at 09:45:06 AM EST
    that PO currently being discussed is available only to those who don't have access to employer-based plans.  If this is correct, there is still no competition for health care plans currently offered by the private sector, so the PO has been reduced to something that will not create competition.  

    Not exactly (none / 0) (#23)
    by MO Blue on Tue Oct 20, 2009 at 10:01:02 AM EST
    The PO is available on a limited basis to small business owners based on the number of employees. IIRC the range in the various bills goes from 10 - 50. In  HR 3200, there is a provision where the range can be expanded in the third year. Not sure how this is handled in the 3 other bills that contain a PO.

    Even the strongest House bill is pretty weak tea but does offer a glimmer of hope that it can be expanded. The bills based on negotiated rates make it even less likely that a PO will offer any competition or even remain viable in the market place.  


    Surrre, there would be competition. (none / 0) (#34)
    by TeresaInSnow2 on Tue Oct 20, 2009 at 11:08:07 AM EST
    People who are on the individual market have NO bargaining power, whereas companies/corporations that supply insurance -- do.  We pay exhorbitantly more than corporations do right now less insurance coverage than corporations provide.

    So having a public option that competes with individual insurance plans is definitely a step in the right direction.  It helps us; people who have absolutely no leverage at present.

    In addition, many of the provisions that insurance needs to address are essentially about us because it is UGLY out here...we're the ones who deal with pre-existing conditions clauses, we're the ones who can be denied insurance coverage altogether because of pre-existing conditions, we're the ones affected by rescission.  

    Group insurees are protected by HIPAA.  If you switch jobs, your "creditable" health insurance time goes with you.  People who've been insured under a group plan for 6 months don't have to worry about pre-existing conditions if they change jobs and go into new insurance.  In addition, group insurance can't deny coverage or rescind when an individual gets sick.  We individuals aren't so lucky.  

    I know about corporate issues (e.g. providing junk insurance to employees).  However, providing help to individual insurees via a PO that we can access is certainly not small potatoes, certainly provides competition to insurance companies for those with the LEAST leverage.

    And if reform encompasses small group plans, it's even that much better, since they are one step above us in (lack of) leverage.


    Teresa, I can almost agree with you (none / 0) (#43)
    by BobTinKY on Tue Oct 20, 2009 at 12:56:29 PM EST
    but if the PO ends up being populated with high risk individuals fleeing increased premiums of private insurance plans, how cheap can it be if it is to be self-funded?

    Yes, low risk individuals purchasing their own plans can get in the PO but I think in relatively short order their numbers will be swamped by the sick whose private insurance premiums suddenly become unaffordable.

    We really need a nation-wide risk pool and either Medicare-like option for all, or companies bidding to service non-discriminatory portions of the single risk pool in a public utility-regulated fashion.


    The Frontline on the financial meltdown (none / 0) (#29)
    by Militarytracy on Tue Oct 20, 2009 at 10:37:22 AM EST
    is tonight.  I've been waiting for this one too.  I watched the previews before dawn today.  I love President Clinton, but he was indifferent to what Greenspan, Summers, and Rubin encouraged in our financial culture.  The stupidest thing the Clenis ever did, and the Clenis was stupidly indifferent to a few things :)  And apparently he doesn't front row or front seat boring women simply because they are the most competent candidate either....what a stupid Clenis :)  There isn't anything smart about indifference to important policy that is the framework we must live in.

    Well (none / 0) (#37)
    by lilburro on Tue Oct 20, 2009 at 11:43:27 AM EST
    Mike Allen is Mike Allen, but here is his report from today:

    EXCLUSIVE: White House officials are confident they will get health care, probably with a TRIGGER public option, by mid- to late December. They DO NOT expect President Obama to sign a financial-regulation bill year in '09. But they hope to have re-reg off both floors by Christmas, with conference over the break. That would allow final passage in January, with the president signing it just before the State of the Union address. Administration officials don't expect serious Senate action on energy/climate until Q1 of next year -- and worry if it gets pushed beyond the spring, it might get put aside until after 2010 elections.

    Not even anonymous sourcing for that though.

    Wow! What an opening for the (none / 0) (#39)
    by MO Blue on Tue Oct 20, 2009 at 12:07:19 PM EST
    Blanche Lincoln version of the "trigger."

    Last week, Blanche Lincoln said she was maybe open to a delayed trigger that might be pulled if the insurance companies are still not behaving nice in 2017. Recently, before the Arkansas State Chamber of Commerce, Lincoln tried to clarify her remarks to reassure everyone that the trigger she was open to would be completely useless.

    Lincoln also clarified a statement she made last week that she was open to the idea of a trigger to introduce a public plan if insurance companies do not make insurance affordable. She told reporters she favors a trigger only if it is not linked to a public plan funded and operated by the federal government.

    "I think there's options or opportunities for things like co-ops, nonprofits, state plans. States could create plans themselves, or even enhance some of the plans that states already have," she said.

    "The trigger part is something that I'm open to. It's just what it triggers," she said. FDL

    I'm sure that will scare the insurance industry into playing nice. We have only to look at their past performance to know that they are great corporate citizens. :-)

    Glad that she clarified her position. People might have gotten the impression that she wasn't completely 100% in the bag for the insurance industry.