President Obama's speech to Congress on health care Wednesday evening succeeded at several levels. Beforehand, observers said that he needed to explain to a confused public what he is proposing and why it makes sense, and the speech did that. Analysts also said that the president needed to shift the momentum from August, to confront the ugly distortions of the opposition, and to mobilize support in his own party. In those respects as well, the speech did all that might have been expected of it.
A supporter of health-care reform leans on her sign during a rally in Belgrade, Montana. (AP Photo/Mike Albans)
Contrary to some overwrought reactions on the left, if a public insurance option fails to make it into this year's health-care legislation, it does not spell the end of worthwhile reform.
The president and Secretary of Health and Human Services Kathleen Sebelius have been entirely correct in saying that the public option is only a small part of the reform effort. The general framework for health insurance that Democrats are advocating does not depend upon a public option. And if a public plan is enacted, it may be so compromised that it could backfire on reformers and become a high-cost alternative rather than the cheaper option that progressives are hoping for.
In "The Perils of the Public Plan," Paul Starr warns that a public-insurance option could turn into exactly the opposite of what progressives want. Here he discusses the problems with the Prospect's two other co-founders, Robert Kuttner and Robert Reich.
According to last week's Washington Post, the public option is the "crux" of the health-reform debate and the "greatest challenge" for Senate negotiators to overcome. That's an accurate description of the current political scene, but it's true only because so many people, including members of Congress, are responding ideologically to the idea of government involvement.
Just around this time in the Clinton administration, the country was consumed with Travelgate, the Vincent Foster case, and other assorted minor and pseudo-scandals. This spring the scandals have been Republican as Sen. John Ensign and Gov. Mark Sanford have admitted infidelities. It's a pattern that seems to follow Obama. When he ran for the U.S. Senate, his chief political adversaries imploded, and when he ran for president, he benefited from the unsteady performance of John McCain and the selection of Sarah Palin.
Sen. Christopher Dodd, D-Conn., accompanied by Sen. Tom Harkin, D-Iowa, at a news conference on health care, Tuesday, June 23. (AP Photo/Harry Hamburg)
In the current battle over health reform, progressives may have set themselves up for trouble by pinning all their hopes on the creation of a government-run insurance plan. A public plan is not a bad idea -- indeed, it could be a critical element in successful reform -- but it could also easily turn out to serve the opposite purposes from the ones progressives intend.
All the proposals receiving serious consideration in Congress allow employers to continue to insure their workers and dependents directly. They also call for new "insurance exchanges" as an alternative means for individuals and employee groups to purchase coverage. If there is a new government-run plan, it would be one of the options in those exchanges.