On Tuesday, Mark offered a history of how the public option became the dominant progressive priority for health reform. This morning, with the future of the public option at risk, its inventor -- Yale political scientist Jacob Hacker -- and its chief political defender, Roger Hickey, co-director of the Campaign for America’s Future -- held a conference call to ask Congress not to vote for health reform that does not include a strong public plan. Sixty House Democrats have already made that commitment, including Progressive Caucus co-chairs Keith Ellison and Raul Grijalva, who were on the call. But there are reports that some members of that group might consider non-profit health care co-operatives -- the Finance Committee's preferred alternative -- a "public option."

Co-ops "are a political solution to a political problem," Hacker said, "unlike the public plan, which is a policy solution to a real world problem. That real world problem is the consolidation of our health system" under a few private insurance companies. The fact that Congressional Republicans have rejected co-ops, which have little chance of effectively competing with for-profit managed care, shows they aren't serious about reform, Hacker said. "They were offered this olive branch, and they basically burnt this to a crisp. ... That's not a response that is reasoned. ... It is a reflection of an unwillingness to bargain." Giving up on a public plan is a "truly ugly idea," he continued.

When it comes to political strategy, the Wall Street Journal reported this morning that the White House and Senate Democrats are considering splitting health reform into several smaller bills, and relying only on Democratic support to pass them. But that would be a mistake, Grijalva said. "We need to do this as a whole and it has to be comprehensive. It's all a package." He added, "to isolate the finances from the public option and jeopardize any of that, I think, is a mistake." But he admitted the Progressive Caucus remains somewhat removed from the negotiating table. "At this point we haven't become allies in the strategy, but I think we're getting there."

I asked Ellison whether Progressive Caucus members were willing to give-up on priorities like Medicaid expansion in order to draw a line in the sand on the public option. He and Hacker didn't answer the question directly, reiterating that the public option was the best way to cut health care costs.

To read Hacker's paper on how to structure a public plan to be most effective, click here.

--Dana Goldstein

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