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Hullabaloo


Tuesday, January 12, 2016

 
Whither the public option?

by digby






























Brian Beutler asks a very good question:

Why aren’t Hillary and Bernie pushing the public option? Paul Waldman breaks down the convoluted fight Hillary Clinton and Bernie Sanders are currently waging over single payer insurance. The short version is that from what we know of Sanders’ earlier preferences, he’d like to consolidate federally subsidized insurance and create a Canadian-style single payer system, administered at the state level.

Clinton says Sanders’s plan would not only be too expensive (contestable), but would empower conservative states to erode their citizens’ health coverage (also contestable). This is to say nothing of the political feasibility question, which she has not yet broached

After all, as he points out the public option has some very important things going for it:
1. It can be administered by the feds.

2. It would reduce federal and individual health expenditures.

3. It can serve as a default plan for the uninsured.

4. It’s an ideal vehicle for migrating toward a single-payer system over time, while mitigating disruption.

He also points out that liberals abandoned the idea once Obamacare became law and finds that odd. I don't, sadly. The public option was an idea championed by the progressive left during the health care fight. And unlike conservatives, when liberals lose a fight like that they walk away instead of doubling down. They accept the defeat as final.

But progressives persist in calling for single payer because that's really a value, not just a policy. They want a universal, national health care plan that is administered by the government, because they believe health care is a right not a privilege. With the ACA in place, I think this argument becomes even more abstract, even as it becomes more real.

The public option was the progressive position in the health care battle because progressives wanted to make that value into something tangible in that process. There was a moment when the value and the policy might have merged. Once that fell apart, the natural response was to go back to trying to make the argument for single payer as an argument about values rather than a specific policy. (It's unlikely more than a very few believe it's actually possible any time soon.)

If Democrats were more like Republicans they would have turned the words "Public Option" into a mantra and kept at it the way the conservatives did about "death taxes" and "tort reform" --- in other words, make the policy itself into the value. But they tend not to do that for whatever reasons. I think this one may have been a missed opportunity. It's possible that the Republicans will win and will overturn Obamacare thus opening the door somewhere down the road for Dems to enact a new system. But that's nothing anyone should hope for.  So, improving Obamacare should at least be on the menu and the Public Option remains the best policy anyone's devised for making sure that everyone can afford insurance and perhaps lay the ground work for an expansion to a single payer system in the future.


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