Liberal Democrats and their allies were concerned enough about Emanuel's remarks to seek clarification from the White House. But the president's statement, while aimed at reiterating his commitment, doesn't actually contradict anything Emanuel said. If, in the end, if Obama decides that a trigger or a cooperative plan keeps insurance companies honest, then he will say he's kept his word on the goals of the public option. So Obama's statement today can be read as both a walk-back of Emanuel's remarks and support of them. When I pointed this out to a White House adviser, the response was succinct: "Mission accomplished."
Schumer has declared the idea dead previously, but sounded more positive Tuesday. "If we can come to some kind of compromise on some kind of co-op situation that really keeps the insurance companies honest, I'm open to it. It can't be two little co-ops in two little places." Schumer even seemed to have compromised on a key sticking point in his negotiations with conservative Democrats. He had previously advocated that the co-op board be linked to the government. Now he says that while "there would be a role for the federal government in setting it up, then it would become independent."
Nonprofit health-care cooperatives won't have any real bargaining leverage to get lower prices because they'll be too small and too numerous. Pharma and Insurance know they can roll them. That's why the Conrad compromise is getting a good reception from across the aisle, just as Olympia Snowe's "trigger" (which means no public option until some time down the pike, and only if Pharma and Insurance don't bring down and extend coverage a tad) is also gaining traction.
The truth is that there's only one "public option" that will truly bring down costs and premiums -- one that's national in scale and combines its bargaining power with Medicare, and is allowed to negotiate lower drug prices and lower doctor and hospital fees. And that's precisely what Pharma and Insurance detest, for exactly the same reason.
Whatever it's called -- public option or chopped liver -- it has to be able to squeeze Pharma, Insurance, and the rest of the medical-industrial complex. And the more likely it is to squeeze them, the more they'll fight it. And the greater the opposition from Republicans, and from Dems who either believe any bill has to have some Republican support or who have sold themselves out to the medical biggies.