According to Greg Sargent, Dean means to throw his considerable weight behind a Democracy for America campaign “to build support for the public insurance option in Congressional districts across the country.” Arshad Hasan, DFA’s executive director, puts it pretty starkly. “We’re drawing a policy line in the sand,” he said. “We’re saying that if the public option is not included, it’s not real health care reform.”
That’s a bit of a weird line to draw. Dean’s health reforms in Vermont did not include a public insurance option. His health reform plan in the 2004 campaign did not include a public insurance option. As a matter of policy, I should say that I strongly favor a public insurance option. But it’s hardly the main determinant of real reform: It’s more the most politically controversial element of reform. And though I’m glad to see progressives fighting for it, it shouldn’t become the be-all end-all determinant of success. You could imagine a very poor health reform that includes a public option and a pretty good health system with no public option at all. At the end of the day, things like subsidies, Medicare’s negotiating power, delivery system reform, comparative effectiveness, and system-wide integration are probably much more important than a public insurance option. Making that the sole effort of your campaign looks to me like going where the controversy is rather than where the policy needs to be.