The Public Option: It's On Obama Now?

The Bystander President can no longer stand on the sidelines on HCR, according to Chris Bowers:

[A] source on the Hill confirms to me the Senate HELP and Senate Finance committees will be merged by an informal, behind the scenes process involving the four major players in the Senate: Tom Harkin (Chair of HELP), Max Baucus (Chair of Finance), Harry Reid (Majority Leader), and the White House. Together, these four will meet and decide what sort of bill to send to the Senate floor for debate and amendments.

. . . [T]he only way a public option ends up in the bill that is sent to the Senate floor will be if the fourth major player, the White House, demands it. It is all up to the White House now. If it pushes for a public option to be included in the health care bill sent to the Senate floor, then a public option will pass as part of health care reform (at that point, all we would need are 60 votes for cloture, and from what I hear we have 57 already). However, if it allows a health care bill to go to the floor without a public option, it is pretty unlikely that a public option will pass as part of health care reform.

I disagree with Bowers in this sense - of course HCR would have a public option of course if Obama wanted it. He does not care. The only way the public option gets in is if the House CPC stands firm. The chances would also improve if 2 or 3 Progressive Senators say they will not vote for cloture for any bill that does not have a public option. Hell, if Ben Nelson can do it, why not Bernie Sanders? but the real block will be, as always, the Progressive Block. The conference report may be where it gets done.

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    BTW (5.00 / 1) (#1)
    by Big Tent Democrat on Wed Sep 30, 2009 at 07:21:58 AM EST
    If we are developing the best Kabuki theater for the Blue Dogs in the Senate, I think bowers has it wrong - it would be best if the public option were added in a House-Senate conference report.

    That way they will never vote for a public option, even on a procedural vote.

    But the public option passes nonetheless via the conference report process.

    In addition (5.00 / 1) (#2)
    by Big Tent Democrat on Wed Sep 30, 2009 at 07:24:09 AM EST
    If you want to know where Obama is, watch McCaskill. If she votes for cloture on a bill with a public option, then Obama did some work.

    Or her teenage daughter (5.00 / 2) (#32)
    by Cream City on Wed Sep 30, 2009 at 11:01:32 AM EST
    told her to vote for cloture, as that's where McCaskill got her political guidance before.

    Typically, the Senate version of a (5.00 / 2) (#9)
    by inclusiveheart on Wed Sep 30, 2009 at 08:10:14 AM EST
    bill tends to win out over the House version in conference.  I think that if there is no Public Option included in the Senate bill when it gets to conference, the likelihood that it would survive that process is extremely low.  The question then becomes, what does the House demand be dropped from the Senate version?  

    And, it is all down to Obama now.  If he signs a bill into law that closely resembles Baucus' proposal, then he's probably toast - but I don't think he gets that - I think that the White House figures that because the bills are all set to go into effect in 2013 and beyond - they'll be held harmless during their key elections - but I don't entirely believe that.  Polls are showing that people are following this debate closely.  I think the first bad political wave will hit when people realize that they have to wait years for "relief"; and I think that the sell out via mandates without a PO - if Baucus' prevails - will play a huge role in the 2010 election and likely 2012 as well.  They are handing the GOP a gift.  It is insane really.

    If we are in Typical Land (none / 0) (#10)
    by Big Tent Democrat on Wed Sep 30, 2009 at 08:14:13 AM EST
    Then of course this is all over.

    The idea here is that PERHAPS, this can be a NON-typical situation.

    If it is typical, then of course nothing good will come from this.


    There were so many Non-typical (none / 0) (#14)
    by Militarytracy on Wed Sep 30, 2009 at 09:28:37 AM EST
    policy "situations" with the Bush administration running things, how can any Democrat sleep at night if they screw all of us and our children over in the name of "typically how we do legislative things on the Hill"?  How tough is Harken?

    Teddy's self-appointed (none / 0) (#17)
    by lilburro on Wed Sep 30, 2009 at 09:32:56 AM EST
    successor, but he doesn't get a lot of press, for whatever reason.

    Is he tough? (none / 0) (#20)
    by Militarytracy on Wed Sep 30, 2009 at 09:37:57 AM EST
    If what Bowers reports is true, and those who will literally decide what sort of bill we get are as reported, is Harken going to walk into the White House for this shake down like a new sheriff?

    At least he's drawing a line in the sand (none / 0) (#23)
    by CST on Wed Sep 30, 2009 at 09:42:15 AM EST
    I'm starting to get optimistic that enough senators are now pushing for this it might actually pass.  For a long time it was only the House members, who have the benefit of being greater individuals in this process.  The senate seems to avoid conflict, so the fact that Dem senators are stepping up here is very encouraging, and also makes me think that maybe they honestly feel this thing can pass.

    I've been distracted these past few weeks (none / 0) (#24)
    by Militarytracy on Wed Sep 30, 2009 at 09:44:32 AM EST
    but it does seem like more Senators are going on the record supporting public option.

    I think you're right... (none / 0) (#52)
    by lambert on Thu Oct 01, 2009 at 06:56:19 AM EST
    ... on the demographics issue you raised elsewhere. My bad.

    Remember, though, that (none / 0) (#13)
    by dk on Wed Sep 30, 2009 at 09:21:25 AM EST
    even if the public option is included, it will be limited to a very small percentage of people even in 2013.  

    The polls have shown that at least 2/3 of Americans actually support a public option that everyone can take advantage of if they wanted.  Thus, it seems to me that the public will be disappointed regardless of whether the bill has the public option that is currently on the table, or no public option.


    Based on what facts? (none / 0) (#15)
    by Militarytracy on Wed Sep 30, 2009 at 09:29:05 AM EST
    Here's the most recent (none / 0) (#19)
    by dk on Wed Sep 30, 2009 at 09:36:34 AM EST
    poll.  The relevant question is #57:

    Would you favor or oppose the government offering everyone a government administered health insurance plan - something like the Medicare coverage that people 65 and older get - that would compete with private health insurance plans?

    65% answered yes.  (26% opposed, 9% didn't know/gave no answer).

    Note the word "everyone" in that sentence.

    A poll published in June in the NYT asked essentially the same question and got a similar result.

    A similar


    Sorry, got the link wrong. (none / 0) (#21)
    by dk on Wed Sep 30, 2009 at 09:38:25 AM EST
    Here it is.

    Sorry, not what I was questioning (none / 0) (#22)
    by Militarytracy on Wed Sep 30, 2009 at 09:39:17 AM EST
    What I was questioning is how few people will actually be helped by Americans having a public option.

    According to the White House (5.00 / 1) (#28)
    by inclusiveheart on Wed Sep 30, 2009 at 10:06:23 AM EST
    plan released after Obama's speech, the Public Option they were talking about would be limited to about 10 million people - less than 3% of the population.  For the most part, all of the bills limit the number of people who would actually qualify for the PO.  None that I know of - that are considered viable bills - include a universally available public option.  To me this isn't just about the PO inclusion, but also the ability for anyone to sign up - or it doesn't really accomplish the goals set forth by the Democratic Leadership - those goals being cost controls, affordability and choice/competition.  With only 3% of the market - a public option won't have the kind of systemic effect that we require to get this healthcare problem under control.

    Exactly what is limiting though? (5.00 / 1) (#33)
    by Militarytracy on Wed Sep 30, 2009 at 11:07:47 AM EST
    Is it that those who are employed and already have insurance through their employment won't be able to purchase the public option?  Because I know a lot of people stuck in jobs they hate due to fear of leaving their insurance behind.  That won't be a problem when we have a public option.  Just because only 3% of the population will immediately be able to take advantage of the choice that a public offers on day one does not mean that that number is not going to grow larger quickly.  We even have people joining the military simply to have insurance.  To me that's criminal.  Nobody should have to pack a weapon and use it when instructed if they would not willfully choose to do so just so that their family can have insurance.  Nobody should have to stay in a deadend job either just to have insurance.  A lot of those things are happening now and a public option would change all of that.

    According to several reports and (5.00 / 1) (#37)
    by inclusiveheart on Wed Sep 30, 2009 at 11:32:54 AM EST
    an interview that I saw with Claire McCaskill discussing the President's plan, their version would be limited to that small number by design because as old Claire said, "We don't want to put the insurance companies out of business," and she went on to affirm in no uncertain terms that she did not want to create a government program - that she would do anything basically not to have any options really be government run.  On that last point, I think there is some ambiguity about who would be running Obama's so-called "public" option - it could be contracted out to the private insurers to run.

    So, no, it will not grow and expand.  Only a small segment of the population would qualify.

    I might qualify as a sole proprietor of a business, but as I understand it, I probably would be sent to an exchange first until they bankrupted me (or came close) after which I might qualify for the PO.  The whole thing is a mess really.  I know having done this for a long time that there are some years in my biz where I might earn enough to be required to purchase from an exchange and then others where I might qualify for the PO -- and that could conceivably change annually - which would be a nightmare to manage from my perspective - and could be a real problem if, say, I do really well for six months and then not so well for eight - and that shift between the higher earnings and lower earnings could easily take place say two months after I'm on one plan that is more expensive that would become unaffordable part way through the year when I can't change plans.  So what happens then?  Am I paying until I can't and then also hit with a penalty for not paying the entire year?

    All I can say is that if Obama really was a pragmatist, he would have gone hard and fast for single payer.


    Ah, ok. (none / 0) (#25)
    by dk on Wed Sep 30, 2009 at 09:49:58 AM EST
    Well, the CBO, and Obama himself in his recent address to congress, are sources for the point that the public option in the bills currently under consideration will be sharply restricted to a small group of people.  Excluded automatically, for example, are all people who work for employers who employ over 10-20 people and who offer private health insurance.

    As for whether those who are ineligible for the very restricted public option will gain anyway, the major argument I have seen (correct me if I'm wrong) is that its very existence will pressure private insurance companies to lower their rates, etc. to be more competitive.  Some of the major counterarguments are 1) the small size of the public option pool won't be great enough to exert that kind of pressure; 2) those who are eligible tend to be those with more health problems, so as a risk pool it could be economically unsustainable.

    Ultimately, both sides base their arguments on theories and models, of course.  But to me it seems the onus is on those coming up with this "uniquely American" solution to explain why it will work, and I've seen little evidence of it.


    There is no evidence whatsoever (none / 0) (#34)
    by Militarytracy on Wed Sep 30, 2009 at 11:10:52 AM EST
    that would indicate that the pool buying the public option on day one is going to be the exact same pool remaining the exact same size buying the public option on day 180.  How many people start a new business and open the doors on the first day to a packed parking lot and a line out front?

    Actually, I thought (none / 0) (#36)
    by dk on Wed Sep 30, 2009 at 11:26:48 AM EST
    that the bills stated the numbers in the pool from day 1 (zero) to day approximately-3650 (i.e. ten years from now) through the restrictions Obama clearly mentioned in his speech.

    I understand the Camel's nose theory, I just don't agree with it.  What seems more likely to me is that Obama, assuming he is in office until 2016, will not expand the program (after all, he is quite explicit in stating how great the restrictions are; even if he wanted to loosen them, which I doubt, his statements on the record would be used against him politically if he tried to make changes; plus, by then he'll be a second termer with much less political capital).

    Meanwhile, because the public option on the table is designed to be economically unsustainable, it will not succeed in doing what those who crafted it are promising it will do.


    Which restrictions that he said in his (none / 0) (#40)
    by Militarytracy on Wed Sep 30, 2009 at 11:44:06 AM EST
    speech, and what bill with what stated numbers from day one to ten years out?  I've not heard about or read such a thing.

    This is from (none / 0) (#41)
    by dk on Wed Sep 30, 2009 at 11:54:53 AM EST
    Obama's speech:

    But an additional step we can take to keep insurance companies honest is by making a not-for-profit public option available in the insurance exchange. Let me be clear - it would only be an option for those who don't have insurance. No one would be forced to choose it, and it would not impact those of you who already have insurance. In fact, based on Congressional Budget Office estimates, we believe that less than 5% of Americans would sign up.

    I don't have time right now, unfortunately, to find the link to the CBO report, but it was widely reported on.  Note also that Obama was being a bit vague in his language.  It's not just that the public option is only an option for those who don't have insurance.  It's not available for anyone whose larger employer offers insurance, even if the employee currently doesn't have it.


    This isn't prohibitive in the way you keep (none / 0) (#42)
    by Militarytracy on Wed Sep 30, 2009 at 12:11:09 PM EST
    insisting that it is.  I don't believe for one single minute that any employer in the United States is going to want to lose all of their best employees to small businesses, where those same workers will also be able to get better insurance coverage for a lot less.  People are making employment decisions right now based on the scarcity of junky growing insurance.  Why will they not be making employment decisions in the future based on the access to best insurance?  And when that dynamic takes place, why are the for profit insurance companies going to not become more competitively priced?  

    Tracy - go to (none / 0) (#45)
    by Anne on Wed Sep 30, 2009 at 01:00:40 PM EST
    pnhp.org; there is a wealth of information there that I think can answer all your questions.

    Anne, I'm navigating the site (none / 0) (#48)
    by Militarytracy on Wed Sep 30, 2009 at 03:11:13 PM EST
    and it is a good site on single payer.  I'm not finding any info on how the public option is going to fail us though or fail to expand. I'm probably not looking in the right spot.  Where do I need to go on the site?

    Try here: (none / 0) (#49)
    by Anne on Wed Sep 30, 2009 at 03:24:32 PM EST
    Ahhh HA! (none / 0) (#50)
    by Militarytracy on Wed Sep 30, 2009 at 03:43:06 PM EST
    The HELP bill "busted up" the Public Option into small acting separate components.....not nationally acting components?  Even if this is passed and is national, in the HELP bill it is not so "national" and is all busted up into tiny pieces like tiny co-ops doomed to fail.  Thank you....I will read on!

    And I would read on but there isn't (none / 0) (#51)
    by Militarytracy on Wed Sep 30, 2009 at 03:48:43 PM EST
    any reading on to be had is there?  This is the last verifiable copy we have of what is going down in the HELP bill as a public option and if this is the "public option" we get....it is doomed at its birth and this is why it cannot expand.......because it really isn't even available.

    # 2 (none / 0) (#35)
    by CST on Wed Sep 30, 2009 at 11:26:23 AM EST
    "who are eligible tend to be those with more health problems"

    Is just not true.  According to this, the group with the largest % uninsured are in the 19-24 age range, and the group with the most # of uninsured are in the 25-34 age range.  When you get to the "Health Status" at the end of the chart, you have significantly more people in the Excellent - Good categories than in the Fair/Poor category.

    When reading the chart, it is important to notice that the percentages add up to 100% when read horizontally not vertically.


    How many of those (none / 0) (#38)
    by dk on Wed Sep 30, 2009 at 11:33:35 AM EST
    19-34 years olds work for employers who offer private health insurance?  It may be that a good number of them do, and up until now simply have opted out because they couldn't/didn't want to make the payments.  People in that group, as I understand it, will not have the public option.  They will be forced to buy through their employer's insurance (or other private insurance) or pay the fine.

    I would say (none / 0) (#39)
    by CST on Wed Sep 30, 2009 at 11:36:28 AM EST
    people in that age group, particularly the 19-25 group, are much less likely to have jobs that offer insurance than those who have been in the workforce longer.

    Exactly (none / 0) (#43)
    by NealB on Wed Sep 30, 2009 at 12:16:26 PM EST
    What's Obama going to say on the campaign trail during the 2012 primary season when he is asked over and over again about why absolutely nothing has changed in regard to health care. Two years, three years after he signs his so-called "historic" reforms and insurance premiums will have gone up another 20% for everyone who can afford it and 50 million people will remain uninsured. I'm already so ready to vote against Obama in the primaries I can't wait.

    I don't share your view that Obama (5.00 / 4) (#18)
    by MO Blue on Wed Sep 30, 2009 at 09:34:21 AM EST
    is merely indifferent to the public option. His actions, that IMO have weaken the chances of obtaining a public option, indicate that he would prefer legislation without one. My guess is that he would prefer legislation that will allow him to put a check mark in the health insurance column without jeopardizing contributions from the health care industry and Phrma.  Would he accept a watered down public option if it would be the only way to get health care passed? Yes, but I don't believe that is what he will work for in the Senate conference.

    As for my sweet Claire, she is a woman of great intellect. She loves Medicare and is against socialized medicine like a public option that could morph into a comprehensive government plan. She is just great at coming up with words of wisdom like these.

    Sen. Claire McCaskill (D-MO) said she was pleased with Obama talking last night about "handcuffing the public option" in an appearance on MSNBC's Morning Joe today. Watch the video below.

    "He talked about handcuffing the public option, which is essential...for a moderate like me," she said. "Without handcuffing it, it could morph into a comprehensive government plan, which I think most moderates can't support." link

    It may be unfair of me, but (5.00 / 5) (#27)
    by Anne on Wed Sep 30, 2009 at 10:04:32 AM EST
    I don't see Obama as indifferent as much as I seem him as colossally indecisive, petrified to commit to one side or the other lest he choose the "wrong" side and his likeability points start to drop.

    I'm not normally much of a Howard Fineman fan, but his column in Newsweek this week seems to be right on the mark.

    From the column:  

    Members of Obama's own party know who Obama is not; they still sometimes wonder who he really is. In Washington, the appearance of uncertainty is taken as weakness--especially on Capitol Hill, where a president is only as revered as he is feared. Being the cool, convivial late-night-guest in chief won't cut it with Congress, an institution impervious to charm (especially the charm of a president with wavering poll numbers). Members of both parties are taking Obama's measure with their defiant and sometimes hostile response to his desires on health care. Never much of a legislator (and not long a senator), Obama underestimated the complexity of enacting a major "reform" bill. Letting Congress try to write it on its own was an awful idea. As a balkanized land of microfiefdoms, each loyal to its own lobbyists and consultants, Congress is incapable of being led by its "leadership." It's not like Chicago, where you call a guy who calls a guy who calls Daley, who makes the call. The president himself must make his wishes clear--along with the consequences for those who fail to grant them.

    I just can't help but think he planned the spur-of-the-moment trip to Copenhagen - he's due there on Friday - precisely because he would rather be anywhere but DC as this health care issue comes to a head.  When all else fails, run.

    He just wants something to get enough votes to put a bill on his desk; he will be more annoyed to not get a bill than he will to get one that isn't going to reform the system - how many more times do we have to hear him say that something is "the best we could do under the circumstances?"  In fact, if they can give him something that has one Republican vote attached to it - even if it has co-ops or triggers or some other gimmick that isn't going to help - that will be all he needs to claim not just victory, but the ever-so-important bipartisan victory.

    I think that Baucus' Finance committee being the primary committee for whatever bill is voted on should tell you everything you need to know.

    What is unfair (5.00 / 1) (#30)
    by jbindc on Wed Sep 30, 2009 at 10:11:28 AM EST
    Is that Fineman is just coming around to this conclusion - 18 months after the fact.

    I agree that it's no coincidence that Obama added the Copenhagen trip - especially as for a week, we've been hearing about Michelle going to lay the Chicago charm/strong-arm on the IOC, and now all of sudden, Barack is added to the list?


    You know what really worries me? (none / 0) (#3)
    by andgarden on Wed Sep 30, 2009 at 07:31:28 AM EST
    The House has waited to pass its own version. Cowards.

    Ithink they will go first anyway (none / 0) (#4)
    by Big Tent Democrat on Wed Sep 30, 2009 at 07:41:38 AM EST
    Which is what matters.

    I envision a typical (none / 0) (#5)
    by andgarden on Wed Sep 30, 2009 at 07:55:18 AM EST
    "but the Senate!" defense.

    House will go first (none / 0) (#8)
    by Big Tent Democrat on Wed Sep 30, 2009 at 08:08:53 AM EST
    If they do not, it will be Obama's doing.

    Oh lord (none / 0) (#6)
    by lilburro on Wed Sep 30, 2009 at 07:56:58 AM EST
    well, Baucus is not not going to support a bill if it has a public option...Harkin said he would ensure a public option was in.  

    This looks like a winner, but I agree Obama doesn't care...and has done such a crappy job at laying the groundwork for a Senate bill with a public option, that I don't think he'll do it without a lot of pressure from his former Senate colleagues (so yeah, I agree with you BTD).  It's funny after all this blather about how Obama wanted to stay out of the process that he's actually going to have to play a very big role...I hope he doesn't shy away from it now, and I wonder how it will play politically that he's finally jumping in.  I know these things are easily forgotten, but it seems so counter-intuitive to his entire public approach of hands off.

    Baucus will vote for cloture (none / 0) (#7)
    by Big Tent Democrat on Wed Sep 30, 2009 at 08:08:25 AM EST
    We actually do not need his vote on the bill itself.

    Who won't vote for cloture though? (none / 0) (#11)
    by lilburro on Wed Sep 30, 2009 at 08:18:31 AM EST
    I mean, I know Obama is irrelevant and everything, but he should've seen this coming a mile away, and his job here has been to a) promote what he wants in a healthcare bill and b) twist the arms of like...3-4 Senators.  Or possibly only Blanche Lincoln, but she seems to be setting herself up for a cloture vote and a no vote on the bill.

    If legislative progress is dependent on the perfection of the executive branch, this country won't see much progress, because presidential administrations are seldom perfect, and they don't have that much power over Congress, anyway. Our political system has to be more robust than that.



    I believe Bernie Sanders (I-VT) is required (none / 0) (#12)
    by Dan the Man on Wed Sep 30, 2009 at 08:33:41 AM EST
    to vote for any procedural motion in the way Harry Reid tells him to due to an agreement between him and the Senate leadership.  In other words, Obama can veto Sander's attempt to not vote for cloture for a non-PO bill because cloture votes are procedural votes.

    Nonsense (none / 0) (#16)
    by andgarden on Wed Sep 30, 2009 at 09:31:24 AM EST
    That's What Wikipedia (2.00 / 1) (#26)
    by Dan the Man on Wed Sep 30, 2009 at 09:52:44 AM EST

    "In exchange for receiving the committee seats that would be available to him as a Democrat, Sanders votes with the Democrats on all procedural matters unless he asks permission of Majority Whip Richard Durbin. However, such a request is almost never made and is almost never granted."


    I wonder if Lieberman was required (none / 0) (#29)
    by MO Blue on Wed Sep 30, 2009 at 10:07:15 AM EST
    to make that commitment. From his statements, it sounds like he considers himself a free agent who is entitled to vote anyway he damn pleases on cloture.

    The person who wrote that (none / 0) (#31)
    by andgarden on Wed Sep 30, 2009 at 10:27:08 AM EST
    Is likely very misinformed.

    You're basing your assertion about Sanders (none / 0) (#44)
    by shoephone on Wed Sep 30, 2009 at 12:32:13 PM EST
    on what wikipedia says?

    That's laughable.


    Obama would not have placed a Baucus staffer on (none / 0) (#46)
    by jawbone on Wed Sep 30, 2009 at 01:20:05 PM EST
    his WH staff to serve a liaison with Baucus if he had not wanted Baucus to develop just the plan that came out of Finance.

    I don't believe there was anyone from Ted Kennedy's staff on the WH roster, but could be wrong.

    I'm without PC presently (fried by electrical outages) and here a the library can't do copy and paste for some reason.   (Maybe I should ask about that, but have limited time to use computers here.

    Anyway, have to emphasize: Obama got what he wanted from Baucus. The rest is all flimflam and bamboozling the voters.

    Big thnx (NOT) to Baucus for making Dems the (none / 0) (#47)
    by jawbone on Wed Sep 30, 2009 at 01:26:20 PM EST
    party of unfunded mandates for every individual and family in this country. For taking $500B out of Medicare and trying to say it won't affect coverage for Medicare recipients. For adding to the Medicaid rolls and telling states to fund it themselves. For ensuring BIPs (Big Insurance Parasites) get to stay well fed by the individual purchasers and then with Federal tax money to help poorer people pay the BIPs. Sheesh.

    Of course, the Big Thanks NOT goes to a large number of the so-called Dems in Congress.

    What a FUBAR. Well, what an Epic Fail, as we are getting so we can all too easily recognize what's going on, making it not "beyond all recognition."

    Repubs are going to have a field day with ads on the mess Dems are making of health care deform.