Pearlstein Channels Ezra Klein: Public Option Is Dead

Congratulations Ezra! You too are now part of the Beltway Media! Steve Pearlstein makes it official:

It's Time to Give Up On the Public Option

. . . [T]here was Howard Dean, the former Democratic Party chairman, over the weekend declaring that health reform without a public option simply isn't worth doing. My colleague Ezra Klein pointed out on his must-read blog that Dr. Dean's fascination with a public option is rather recent since it was nowhere to be found in the reform plan he proposed when running for president in 2004.

Or how about MSNBC's Rachel Maddow, who opined that the failure to deliver on a public option would represent nothing less than the "collapse of political ambition" for American liberalism? The public option has become for the left what "death panels" have become for the right -- an easily understood metaphor that can be used to wage an ideological war over the issue of Big Government, and mostly a sideshow.

(Emphasis supplied.) You've made it Ezra. Enjoy the cocktails.

UPDATE: Ezra is "shocked" to find himself used as a cudgel against the public option. Bah.

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    Digby Called It (5.00 / 1) (#3)
    by kidneystones on Wed Aug 19, 2009 at 07:38:28 AM EST
    When she suggested it might be time for the President to flex with Dems unwilling to tow the line. Problem is, there's no guarantee the blue dogs are the ones on their way under the bus.

    If you read the coverage of the messages emanating from the WH, especially in the Wapo, it seems the WH is making very clear that no single issue will be allowed to derail health-care 'reform'.

    Which means the folks on the receiving end of the beating may well be Digby and company, with Ezra and Matt explaining that a half-loaf victory is the best a Dem president with a majority in Congress can expect.

    A half-loaf victory? (5.00 / 3) (#8)
    by MO Blue on Wed Aug 19, 2009 at 08:10:36 AM EST
    A few years after implementation, when insurance premiums continue to increase and coverage continues to decrease and the cuts to the Medicare and Medicaid budgets are beginning to be felt, I wonder how many people will believe that they received a half loaf?

    Also, isn't a trillion dollars a lot to pay for half a loaf?


    Obama's primary problem is that (5.00 / 8) (#12)
    by inclusiveheart on Wed Aug 19, 2009 at 08:14:55 AM EST
    there is no line to toe.  He has not defined a clear outcome for this "reform".  He has a list of stuff, but that doesn't amount to a comprehensive plan that could be considered a real end goal.  The reality is that the heart of the problem of healthcare in this country is in access/delivery and administration.  Which means that, contrary to Obama's and others' claims that the construct is a "side show", how this plan is structured is actually a critical consideration in creating a workable and meaningful solution.  The Democrats pushing the notion that having a Public Option is optional only leads me to conclude that they don't understand the problem or how deep it goes - and basically makes me think we might well be better off without any legislation from this crowd at all.  I believe they are poised to do more damage than good based on what I've seen coming out of both the House and the Senate.

    Yeah (5.00 / 2) (#17)
    by Ga6thDem on Wed Aug 19, 2009 at 08:18:59 AM EST
    you are getting to heart of the problem. I think all of them have cadillac insurance at bargain basement prices so they really dont understand or want to understand the issues here.

    I know what you are saying is true (5.00 / 3) (#29)
    by Militarytracy on Wed Aug 19, 2009 at 08:48:43 AM EST
    And the current structure is heading for an implosion.  I just hate having to challenge the innocent to survive the chaos of implosion. The people most in need seem to me to have struggled a lot already.  Sadly though I look at the floor and agree with you.  Hand outs to the insurance industry right now only prolong our agony of having to be ripped off by them.  Nothing done would be better than buying more hell for all of us.  If healthcare has to be a capitalist venture then let the market correction go down.  But it probably won't.  Obama will save them.

    No public option (5.00 / 2) (#5)
    by MO Blue on Wed Aug 19, 2009 at 08:02:59 AM EST
    No co-ops (a horrible idea anyway) and what we are left with is a trillion dollar giveaway to the insurance industry. The only thing left to even attempt to keep the industry from continual escalation of premiums accompanied by continual decreases in coverage is a plea to Please, pretty please play nice.

    Ya, that will work.

    Labor Weighs In On Public Option (5.00 / 4) (#36)
    by MO Blue on Wed Aug 19, 2009 at 09:34:42 AM EST
    In an interview with the Huffington Post on Saturday, Richard Trumka, the secretary-treasurer and likely next president of the AFL-CIO, said his federation is drawing a line in the sand when it comes to a public option in the health care bill. Lawmakers who don't support the provision, he said, shouldn't take anything for granted.

    "We'll look at every one of their votes," Trumka said after his speech at the Netroots Nation convention. "If they're against the Employee Free Choice Act, if they're against health care for that reason, I think it'll be tough for them to get support from working people."
    Trumka's warning shots come at a time that the AFL-CIO is charting out a more aggressive campaign to target lawmakers who, as one official put it, "take labor's help but don't vote for labor's interests." Part of that process is to hold out the prospect of electoral consequences.

    I was never sure about the co-ops (none / 0) (#7)
    by Militarytracy on Wed Aug 19, 2009 at 08:09:30 AM EST
    I've been part of co-op situations in the past that weren't about healthcare that seemed to work well.  I was part of a utility co-op once....that was great! But are co-ops even off the table now?

    Republicans are saying that (5.00 / 1) (#13)
    by MO Blue on Wed Aug 19, 2009 at 08:16:50 AM EST
    they don't plan to vote for co-ops.

    Here is a little more info about health care co-ops.
    Co-ops are highly experimental. Most efforts in the past have failed. The U.S. General Accounting Office produced a report in March 2000.

       "The cooperatives' potential to reduce overall premiums is limited because (1) they lack sufficient leverage as a result of their limited market share; (2) the cooperatives have not been able to produce administrative cost savings for insurers; or (3) their state laws and regulations already restrict to differing degrees the amount insurers can vary the premiums charged different groups purchasing the same health plan."

        Part of the problem was availability. While cooperatives sought to provide more choice of insurance to participants, oftentimes they failed to get consumers a broader range of options. "Not all plans are available in all areas served by each cooperative, and individual employers using some cooperatives may limit the choice of plans their employees can select," the study concluded.

        And without a large number of participants, co-ops essentially were subject to the whims of the insurance market, unable to use market influence to get consumers better deals on coverage. "None of the purchasing cooperatives we reviewed had a large enough market share to create bargaining leverage and therefore had a limited ability to significantly increase the percentage of small employers offering coverage in their state," the study found.link

    It is theoretically possible (5.00 / 5) (#23)
    by Steve M on Wed Aug 19, 2009 at 08:26:06 AM EST
    that regional co-ops could have the sort of market share, and thus bargaining power, that some of the smaller co-ops have failed to demonstrate in the past.

    The problem is, as Jay Rockefeller points out, there's just very little in the way of precedent to tell us one way or another.  It's nothing but a gamble, a gamble we're taking because the battle-tested public option is deemed ideologically unacceptable by some.

    So I don't think we can say for sure that co-ops will fail, but I do think we can say that it's pretty foolish to be staking everything on a complete gamble of that type.


    I have friends who are currently (5.00 / 5) (#33)
    by MO Blue on Wed Aug 19, 2009 at 09:00:40 AM EST
    suffering because of insurance industry practices. People who are completely underinsured because that is all they can get. People who are wasting their limited resources of energy fighting with the insurance company to be allowed the life saving treatment their doctors have proscribed. I, also, had my insurance refuse to cover treatment the same way. Fortunately, my case was not quite so dire as some of my friends. Not to mention that my current employee retiree insurance premium is 8 times larger than it was two years ago for less coverage.

    So this is personal to me. I agree with Rockefeller and don't feel this is the time to gamble. Real people need help now. They don't need to be part of some unnecessary experiment.  


    Well (none / 0) (#43)
    by Steve M on Wed Aug 19, 2009 at 10:01:40 AM EST
    if we end up with co-ops in the final legislation, I am certainly not going to move to Russia or start voting for Nader or anything like that.  It might work.  It probably works on paper given the right set of assumptions.

    But I think as political strategy, the unions and other interest groups on the left are correct to make the public option a line in the sand.  If I say "I'd really like to settle this case for $40,000, but you know, if I absolutely have to I could probably live with paying $60,000," my chances of ultimately settling for $40,000 are pretty slim.  But just between us, I think it's important for people to understand that co-ops are not some kind of guaranteed disaster.


    No turning back now (5.00 / 1) (#46)
    by mmc9431 on Wed Aug 19, 2009 at 10:27:28 AM EST
    I'm afraid that if we walk away, it will be like immigration reform. No one will want to dive back in. Politician much prefer to shake hands, kiss babies and take the money (oerks) and run.

    I do tend to dream (none / 0) (#18)
    by Militarytracy on Wed Aug 19, 2009 at 08:22:05 AM EST
    I made an assumption that if co-ops were in the game that Obama would bankroll us on start up costs so that actual coverage and services worthy of joining up could be provided right off the bat.  

    Your assumption is right (5.00 / 1) (#40)
    by gyrfalcon on Wed Aug 19, 2009 at 09:50:02 AM EST
    as I understand it.  One of the main reasons the GOPers give for now opposing even co-ops is precisely because the fed. govt. is to set them up and fund start-up costs, then theoretically turn them over to members to manage.  GOPers say if they gov. is involved, it will never stop being involved.

    Oh, like how we have to get involved (none / 0) (#60)
    by Militarytracy on Wed Aug 19, 2009 at 04:23:10 PM EST
    in the whole situation right now in order to save the insurance companies two years from now? That's government money too.

    The co-op idea is a bait and switch. (5.00 / 6) (#20)
    by inclusiveheart on Wed Aug 19, 2009 at 08:23:59 AM EST
    All you really need to know is that there would not be one national co-op - which is the only model that would have a hope in hell of competing effectively especially in the low population states.  They are going to be set up to fail and it won't take long before the private insurers and others will say "I told you so" and take over the policies.  That's the idea with these co-ops - to make you think you have an option - but pretty much still fully insulate the private insurers from true competition.

    There you have it (5.00 / 4) (#26)
    by Militarytracy on Wed Aug 19, 2009 at 08:38:49 AM EST
    You always seem to find the skeletons in the current closets.  No national co-op.  And Wyoming, Idaho, Utah will stay Redder than Red because the citizens will be shafted by "liberal ideas" again.

    Well, I spent half my life in Wyoming (none / 0) (#52)
    by Militarytracy on Wed Aug 19, 2009 at 11:36:20 AM EST
    Wyoming always always always votes a Democrat into the Governors mansion to prevent the Republicans from completely losing their minds.  Wyoming is more pliable than you would like it to be.  Old habits die hard but everything dies if you don't feed it.

    You are saying that Wyoming will (none / 0) (#59)
    by Militarytracy on Wed Aug 19, 2009 at 04:16:22 PM EST
    never vote for Dems.  You are wrong.  They do vote for Dems.  But if you keep feeding them solid reasons why liberal ideas screw them over every time you will make yourself right as far as us ever getting a Dem from WY to DC.  Good for you

    Don't be weird? (none / 0) (#62)
    by Militarytracy on Wed Aug 19, 2009 at 04:39:57 PM EST
    Okay, what did your initial comment to me mean then?

    Based on my understanding the (none / 0) (#48)
    by inclusiveheart on Wed Aug 19, 2009 at 10:45:49 AM EST
    issue is that the co-ops would be separate and distinct risk pools which as I said would put them at a great disadvantage in small population states.  Aetna et al operate differently in each state, but all of those divisions still come under a larger umbrella organization - that would not be the case with the co-ops.  Therefore, there is no way for the Montana co-op to make up for the cost of critical care by allocating the risk in another state that might have a higher population.  Conrad's co-ops are set up to fail.

    You are wrong. (none / 0) (#50)
    by inclusiveheart on Wed Aug 19, 2009 at 11:14:21 AM EST
    When Aetna Montana suffers a loss in a given year, they can make it up by doing better in California - they also set rates higher in different markets where they think they can get higher fees in order to offset the costs in other regions.  None of these options would be available to independently operated co-ops under Conrad's plan.  These co-ops are set up to fail.

    The Washington State co-op has (none / 0) (#56)
    by inclusiveheart on Wed Aug 19, 2009 at 12:41:35 PM EST
    done nothing to control costs because they do not have the leverage in buying power.  If you say that a key element to real reform is controlling costs, then the co-ops will be a failure as designed.

    None of what I've been talking about is hypothetical.  It is real.  It is certainly your right to be Pollyanna about the co-ops that Conrad has proposed, but the rest of us don't have to be.


    It is interesting (5.00 / 3) (#6)
    by Steve M on Wed Aug 19, 2009 at 08:05:00 AM EST
    that Ezra adopted the Beltway style of simply reporting that Dr. Dean said he was wrong, without either (1) explaining why, in fact, Ezra still thinks he was right, even though Dean says he was wrong; or (2) admitting that Ezra was actually wrong.

    I confess I don't recall the details of Dean's health care plan from 2004; but if Dean said it included a Canadian-style plan for everyone over age 25, which would be a public option, I'm inclined to think he's not just making it up.  So after he tells Ezra he's wrong, how the heck does Ezra go ahead and make the claim anyway?

    But yeah, this is how the MSM does it, and Ezra has learned his lessons well.  "The Washington Post confirms that Dean didn't have a public option in 2004!"

    It is a red herring to say someone is (5.00 / 7) (#16)
    by inclusiveheart on Wed Aug 19, 2009 at 08:18:18 AM EST
    wrong about something just because they weren't proponents five years ago.  That is a specious argument.  So if I hated tomatoes when I was little and love them now I am "wrong" when I say tomatoes are great now?  I mean come on.  It is a ridiculous, nonsensical attack.

    Well (5.00 / 2) (#19)
    by Steve M on Wed Aug 19, 2009 at 08:22:40 AM EST
    Ezra's argument is something like "how can Dean say there can't be any real health care reform without a public option, when he didn't even propose a public option himself in 2004?"  In other words, he's suggesting that Dean couldn't take the position that the public option is essential without admitting that his own plan from 2004 was inadequate.

    The problem is that Ezra appears to be flat wrong about whether Dean proposed a public option in 2004.  In fact, Dean told Ezra he was wrong, Ezra printed Dean's claim that Ezra was wrong, but Ezra never retracted his claim or explained why he thought his claim was still valid despite Dean's denial.

    Sure looks to me like Dean proposed a public option in 2004, which makes the whole damn thing specious.


    And he is (5.00 / 2) (#21)
    by Militarytracy on Wed Aug 19, 2009 at 08:24:09 AM EST
    I remember Dean's promises.  He promised quality coverage to everyone.

    Sure all that you say is true too. (5.00 / 4) (#24)
    by inclusiveheart on Wed Aug 19, 2009 at 08:28:49 AM EST
    But I fail to see how it is that attacking someone for not being in favor of something in years past as your sole argument against an idea could be taken seriously even by the writer.  It is pathetic and if I were Ezra, I'd be embarassed to be the author of such a woefully inadequate debate tactic.

    Dean is saying that his plan (5.00 / 1) (#22)
    by MO Blue on Wed Aug 19, 2009 at 08:25:56 AM EST
    had components in his health plan that would today be labeled public options. IOW, the elements were there, just not the specific words.

    Sure, but why does Dean have to defend (5.00 / 5) (#25)
    by inclusiveheart on Wed Aug 19, 2009 at 08:34:14 AM EST
    a plan created in a totally different political argument in the first place?  That's what I don't get.  Dean's 2004 plan is not at issue.  The junk they are writing on the Hill today - now - in 2009 - is the issue.  If Ezra has no better argument against the Public Option in his come back to Dean than to drag out old campaign documents from 2004 that have little to do with the present debate then he ought to concede defeat in my opinion.

    Don't disagree with what you are saying (none / 0) (#28)
    by MO Blue on Wed Aug 19, 2009 at 08:41:25 AM EST
    Even worse than that (5.00 / 3) (#37)
    by ruffian on Wed Aug 19, 2009 at 09:35:51 AM EST
    Ezra was even pretending that because Dean didn't use the words "public option" back then (nobody was using those words in 2004), what he proposed then is not what he supports now. You have to be deliberately obtuse to make that argument.

    It seems to have boiled down to (5.00 / 1) (#10)
    by lilburro on Wed Aug 19, 2009 at 08:13:59 AM EST
    do you think the patterns of consumers are the problem or do you think insurance is the problem?  And amazingly, people like Pearlstein believe it is a consumer problem.

    It's not Ezra's fault that Pearlstein cherry picked his articles, but it is Ezra's fault that he has spent all his valuable column inches covering Obama's @ss instead of being a relevant advocate's voice in the debate.

    it's (5.00 / 1) (#14)
    by Ga6thDem on Wed Aug 19, 2009 at 08:17:14 AM EST
    not that amazing that someone would think the consumers are the problem. It's a very prevalent thought in the insurance business. I had one underwriter tell me one time that we (the insurance company) were doing the consumers a favor by providing or allowing them to buy insurance.

    Why? (5.00 / 2) (#34)
    by mmc9431 on Wed Aug 19, 2009 at 09:06:07 AM EST
    I'm still at a loss as to why Ezra would take on Dean and the progressive community over health care. These are the very people that have given him his 15 minutes of fame.

    By closing his mind to campaign promises and trying to split hairs with Dean on semantics, he just loses credibility.

    You really can be supportive of your candidate without being a shill. As important an issue as health care has been throughout the entire primary and election cycle, there's no redefining it now.

    NY Times article (5.00 / 2) (#38)
    by mmc9431 on Wed Aug 19, 2009 at 09:37:32 AM EST
    The NY Times had an article today stating that Dem's have decided to go it alone on HCR due to lack of support from Rep's. I sure hope that's true.

    The only way that the opponents will be satified is to see the whole deal fold.  Obama and the Dem's need to put together the best package they can and ram rod it through. Dem's are going to own this anyway so they may as well do it right. They aren't going to get a second chance.

    I passed them already this morning (none / 0) (#1)
    by Militarytracy on Wed Aug 19, 2009 at 07:19:44 AM EST
    We were out of milk.  Two miles down the road in front of the local apartment complex I passed them up again, the people we don't have the common sense to feel ashamed about royally shafting were standing on the corner waiting for their bus.

    Are you talking (none / 0) (#2)
    by hookfan on Wed Aug 19, 2009 at 07:37:14 AM EST
    about the left of the left or Pearlstein and klein?

    I'm talking about that low income to middle (5.00 / 1) (#4)
    by Militarytracy on Wed Aug 19, 2009 at 07:51:42 AM EST
    class child.  Of course the upper middle class child is being robbed.  I passed a couple of those too.

    Yeah (5.00 / 2) (#9)
    by hookfan on Wed Aug 19, 2009 at 08:12:11 AM EST
    Sad. . . and it's even more sad when one attaches the fact that the old, the sick, the disabled, in fact all of us who are not the upper 5% income bracket are being robbed. In july foreclosures were up 30% over last year, consumer spending was down, and job losses were still high, but Goldman was giving huge bonuses!
       I live in a small town. People who tout we're out of the recession seem so detached from the world in which I live.

    And (5.00 / 5) (#11)
    by Ga6thDem on Wed Aug 19, 2009 at 08:14:53 AM EST
    the pundits are overjoyed at a jobless recovery it seems. That just goes to show how out of touch they are.

    I live in a terrible bubble (5.00 / 4) (#15)
    by Militarytracy on Wed Aug 19, 2009 at 08:17:19 AM EST
    I guess my spouse had a two hour loud discussion with his office mate yesterday.  Office mate was upset that all these people who didn't want to pay for their healthcare and wanted to spend that money on "fun" things were whining.  This from someone who has never ever paid an insurance premium in his adult life and has always had coverage.  My family is all private sector folks, some small business owners....it is shocking to hear a soldier talking about people he doesn't even know that way.

    Hypocrites everywhere (5.00 / 5) (#27)
    by mmc9431 on Wed Aug 19, 2009 at 08:39:08 AM EST
    Yeah, I have a friend who has two daughters, both on Medicaid and one in public housing. (Yet they're far from a poor family) She's continually railing about those "people" that are ripping us off.

    Again, people only want to see things through their own narrow vison. It's only wrong when other's do it.


    It's Funny (5.00 / 1) (#35)
    by daring grace on Wed Aug 19, 2009 at 09:11:48 AM EST
    I don't spend too much time worrying about what individuals might be cheating me somehow with their own choices and behavior.

    When I do think about it, as when I'm countering the arguments of someone like your spouse's office mate, I'm more likely to get infuriated by the undeserving rich, and the corporate welfare kings and queens than the people struggling paycheck to paycheck using food stamps and then also using their own cash to buy a birthday cake and a six pack. [This was an outraged observation one of my brothers shared with me once when he came home from the market.]

    Probably a left/right thing whether you demand the powerful or the disempowered carry more of their own weight.


    Wouldn't it be nice (4.33 / 3) (#30)
    by hookfan on Wed Aug 19, 2009 at 08:52:58 AM EST
    if we actually had the option of paying for real affordable health care? Paying for insurance does not mean health care. Example 70% who get a major illness while insured still go bankrupt.

    And Tricare doesn't mean quality (none / 0) (#31)
    by Militarytracy on Wed Aug 19, 2009 at 08:58:54 AM EST
    care either.  My husband has something arthritis going on right now for the first time.  They sent him home with Motrin first....duh...I already gave him a bucket of that.  A month later with no improvement they decide to do bloodwork yesterday.  He has a narcotic script when the pain gets bad....My God it has been for five weeks now....and Tramadol.  Guess when he got an appointment to go over his labs?  September 15th!  The meds have done nothing wonderful yet either, but I can hope that soon they will because if they don't.....suffer dude, we can't get you in.

    If there was a pay option out there (5.00 / 1) (#32)
    by Militarytracy on Wed Aug 19, 2009 at 09:00:00 AM EST
    that delivered quality coverage and care....I would pay gladly whether I had crappy Tricare or not!!!!

    Hookfan, link please? (none / 0) (#39)
    by gyrfalcon on Wed Aug 19, 2009 at 09:45:48 AM EST
    for that statistic?  I think you have it backwards.

    It's 70 percent of people who go bankrupt because of medical expenses have insurance.

    Let's not, please, make it light years worse than it actually is.


    My bad (none / 0) (#55)
    by hookfan on Wed Aug 19, 2009 at 12:40:16 PM EST
    You're right. I was quoting the consumer affairs article from feb 2005 which states most of those bankrupted had health insurance: "most of those bankrupted by illness had health insurance. More than three-quarters were insured at the start of the bankrupting illness. However, 38 percent had lost coverage at least temporarily by the time they filed for bankruptcy." The controlling sample is those bankrupted by illness, not all bankruptcies.
       However, medical bills (i.e. illness) is a major cause of bankruptcies (50%), along with job loss, and divorce.

    equating death panels & a public option... (none / 0) (#51)
    by Dadler on Wed Aug 19, 2009 at 11:19:14 AM EST
    ...rhetorically as somehow representing the same kind of psychological process does, and quite bluntly, elimnate you from being considered a rational voice in this particular debate.