I would have preferred a single-payer system like Medicare but became convinced earlier this year that a public, Medicare-like optional plan was just about as much as was politically possible. Now the White House is stepping back even from the public option, with the president saying it's "not the entirety of health-care reform," the White House spokesman saying the president could be "satisfied" without it, and Health and Human Services Secretary Kathleen Sebelius saying that a public insurance plan is "not the essential element."
Without a public Medicare-like option, health-care reform is a band-aid for a system in critical condition. There's no way to push private insurers to become more efficient and provide better value to Americans without being forced to compete with a public option. And there's no way to get overall health-care costs down without a public option that has the authority and scale to negotiate lower costs with pharmaceutical companies, doctors, hospitals, and other providers -- thereby opening the way for private insurers to do the same.
It's been clear from the start that the private insurers and other parts of the medical-industrial complex have hated the idea of the public option, for precisely these reasons. A public option would cut deeply into their current profits. That's why they've been willing to spend a fortune on lobbyists, threaten and intimidate legislators and ordinary Americans, and even rattle Obama's cage to the point where the administration is about to give up on it.
The White House wonders why there hasn't been more support for universal health care coming from progressives, grass-roots Democrats, and independents. I'll tell you why: It's because the White House has never made an explicit commitment to a public option.
Sen. Kent Conrad's ersatz public option -- his regional "cooperatives" -- won't have the scale or authority to do what a public option would do. That's why some Republicans say they could buy it. What's Conrad's response? "The fact of the matter is there are not the votes in the United States Senate for a public option. There never have been," he tells FOX News Sunday. Conrad is wrong. If Obama tells Senate Democrats he will not sign a health-care reform bill without a public option, there will be enough votes in the United States Senate for a public option.