Nate Silver at 538 says the public option is probably dead but the bill is worth passing anyway:
Is a bill without a public option worth passing (if you're a Democrat)? From a near-term political standpoint, almost certainly yes. Bill Clinton suggested on Thursday that the President's approval rating would get a five-point boost the moment that health care legislation passed with his signature. I don't know if that's exactly right, but this is certainly a better scenario for Democrats than the world in which health care reform fails and they're getting blamed by pretty much everybody and have nothing much to run on in 2010.
As to whether a bill without the public option can pass, he acknowledges the opponents Jane writes about, but says:
If you re-inserted a public option, you might lose as many Blue Dog votes as you gained back from progressives. Even if you managed to avoid that, the public option would probably get killed by the Senate. Maybe you could gamble on a bill with a public option passing the House, a bill without one passing the Senate, and then the House bill winning the floor fight on the conference report. But this is usually not what happens. Instead, the Senate tends to win floor fights over conference reports, since they can filibuster them.
Nate seems to take a third approach: Pass the health care bill without the public option, and then reintroduce the public option in 2010:
If a health care reform bill passes, then the government will paying for private insurance coverage for some low-to-middle income individuals. This will tend to give everyone a more direct interest in cost containment: if a low-income family's insurance coverage is costing more than it should because of the absence of competition from a public option, it will be the taxpayers making up the difference....
.... if someone then proposed a public option -- a provision that would spare $150 billion from the public dole and which would give consumers more choices -- it would seem to have a fairly compelling case....When taken as a standalone measure, its cost savings would be more transparent and its opponents would have less ability to confuse the public about its costs and benefits.
I don't know much about the intricacies of the public option. But from what I know about how Congress works and how they always water down the good bills to get them passed out of fear that getting nothing passed will provide heavy artillery to the opposition and anger among their own constituents in the next election, I'll venture this:
1. Obama needs to pass a health care bill now or he faces big trouble in 2012, as do a lot of Democrats in Congress. The failure to pass a bill will re-invigorate Republicans and anger Democrats. Passing a bill without the public option may anger Democratic constituents, but not to the point where they'd vote for a Republican next time around.
2. Passing the public option in the House is only half the battle. The Senate comes next. Obama may know it won't survive a Senate battle which is why he's willing to capitulate on it now.
3. Never trust a politician who says we're passing a half-as*ed bill now because otherwise we get nothing, but don't worry, we'll come back with a new bill to change it once it's law. It doesn't happen.
The question people need to ask themselves is whether passing health care without a public option is better than no health care bill at all. Not just in terms of the bill, but in terms of keeping control of Congress and even the White House in coming elections.
I'm still not completely sold on the cost containment measures. I worry that by the time the bill emerges from a House-Senate conference, there will be (1)major cuts in Medicare benefits through either reduced pay to doctors (which will mean fewer doctors willing to treat medicare patients) and restrictions on coverage of particular tests and treatments and (2) health insurance companies will decide to eliminate top-end plans or else raise premiums on them through the roof.
As for mandating that everyone have insurance provided by private insurance companies instead of a government run collective, that's going to be happen even with the public option. Remember what President Obama said yesterday:
[L]et me just describe what this issue of the public plan is all about. ... we've still got 46 million uninsured and I think it is the right thing to provide them with some help. Most of them work. Most of them are responsible. But their employer -- maybe they work for a small business -- their employer just can't afford it because they don't have the bargaining power to get low enough rates to cover all their employees. That's a big category of the uninsured.
So what we've said is, let's set up what's called a health insurance exchange. It's essentially a marketplace where you could go online and you'd have a menu of options, most of them private insurers -- Aetna, BlueCross BlueShield -- insurance companies that wanted to participate, and they would list a range of plans just like when Mike and Mark want to get health insurance as members of the Senate, they go on to this exchange for federal health care -- for federal employees, and they select which plan works best for their families.
So we want everybody to be able to access that and choose which plan works best for them. And if they can't afford it, even though we'd have a lot of bargaining power, we'd be able to get the same kinds of rates that really big companies are able to get or the federal system is able to get, some people will still not be able to afford it, and then we would provide some subsidies.
And there would be certain rules governing any insurance company that's participating: You couldn't exclude for preexisting conditions; you couldn't have a lifetime cap; you'd have to limit out-of-pocket expenses. So all the insurance rules that I talked about, that would be part of the deal if you as an insurer wanted to sell insurance through this exchange.
Sounds to me like the private insurance companies are still going to be the major player when it comes to the public option. The Government isn't setting up an insurance company, it's only going to provide subsidies to those who can't afford insurance even under the option's better, bargained-for rates.
Whatever bill passes is going to take years to implement. I'd rather have Democrats in control of the White House and Congress than Republicans to deal with problems it engenders (and all other matters.) So for now, while part of me says we need to study this bill more and consider other options and all the ramifications (remember the Patriot Act, Act in Haste, Repent at Leisure) and reserving the right to change my mind, I'll say just get the bill passed. The worst fate is passing no bill at all.
