Ezra makes a good point: The administration's recent ambiguity on the public option is not unusual; various members of the executive branch have been saying since April that the public option is not an absolutely essential part of reform.

That said, as I wrote last week, Obama's decision to give Max Baucus and his Gang of Six near-veto power over elements of the reform package gave the death of the public option an air of inevitability. So if the public option will almost certainly be bargained away, the question then becomes: What health reform goals should progressives hold absolutely fast to, as the ground shifts? (I'm taking for granted here that reform is still likely to prevent insurance companies from denying coverage due to pre-exisitng conditions, and that any legislation will do away with the practice of capping a policy-holder's lifetime health spending, which has contributed to shameful rates of health-related personal bankruptcy.) A few thoughts:

  • National health insurance exchanges, instead of state-level exchanges. The exchange is the marketplace in which people will buy coverage, especially those who are unemployed, underemployed, or have been denied coverage in the past. Making sure this pool is as broad and large as possible will bring down costs for individuals and force the insurance companies to compete with one another more aggressively.
  • Health insurance coverage for all existing and future American citizens and legal residents. Read more about immigration and health reform here.
  • An expansion of Medicaid to all men, women, and children living at or below 133 percent of poverty. Currently, Medicaid, the federal insurance program for the poor, is open only to the disabled, children, and some single moms.
  • Insurance subsidies for as many middle-class Americans as possible. The House and HELP committee bills offer subsidies to individuals earning as much as $43,320 a year or families of four earning $88,200. The Gang of Six has signaled it will cut those numbers down to $32,490 for an individual and $54,930 for a family. But progressives should be demanding more subsidies in exchange for letting go of the public option.

--Dana Goldstein

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