THE TREATMENT OCTOBER 21, 2009
Armed with favorable cost estimates from the Congressional Budget Office and emboldened, perhaps, by the self-destructive behavior of the health insurance lobby, House Speaker Nancy Pelosi plans to propose that her caucus unite behind a reform bill with a strong public insurance option. She will do so at a Wednesday meeting of House Democrats, according to The Hill's Mike Soraghan, who was (I think) the first to report the story.
Pelosi's actions have provoked two very different reactions from within the reform community: Glee and fear.
The glee comes from people who think Pelosi is making a smart strategic move. Yes, a strong public plan remains a tough sell, particularly with centrists in the Senate. But precisely because the Senate will pull the bill to the right, it's critical that Pelosi pull it to the left while she can. The public option is gaining momentum right now, thanks to strong polling numbers and a realization, among members, that requiring people to get insurance is a bad idea if the available insurance options aren't very good.
It helps, too, that CBO has apparently determined the strong public option--which would pay at rates pegged to five percent above Medicare--could save somewhere in the neighborhood of $100 billion. Given what happened during the stimulus debate, when centrists in the Senate successfully pushed to scale back the bill, it'd be foolish of Pelosi not to anticipate that move.
What's more, this way Pelosi can force the Blue Dogs, many of whom oppose the public option, to confront the trade-offs as they exist. If they don't want the public option, she can say, how else will they find the money the public option might save?
The fear comes from people who think this move will backfire--by alienating the Blue Dogs, centrists in the Senate, or both. These people note that we're still not all that far removed from August, a time when reform's very survival seemed very much in doubt.
Things look good now, the argument goes, because of united Democratic consensus around the basic principles of reform. But the consensus is fragile. Senators Kent Conrad and Ben Nelson have offered hints they're open to some sort of compromise, but Pelosi's proposal surely goes too far for them. And precisely because centrists in the Senate will never go for such a bold public option, the House's Blue Dogs will scream, particularly if they are forced to commit on this before even seeing what the Senate does.
Meanwhile, the public option threatens almost every special interest group in one way or another. I.e., it's not just the insurers. Fighting all of them, as this argument goes, would be suicidal--even at this late stage of the debate. It's fine to take advantage of the momentum behind the public option. But proposing something this far out, the critics say, could make a workable compromise less likely rather than more.
It's a predictable split, to be sure, although the divide seems to be have as much to do with proximity to negotiations as it does to substantive feelings about the public plan. More often than not, the people celebrating are watching the debate from a distance. The ones sweating it out tend to be the ones in the thick of things, trying to piece together a deal.*
That doesn't mean the latter are correct, by the way. Having an inside view can give you unique insights. Or it can give you tunnel vision.
For what it's worth, I think both arguments have a certain logic to them. This is a judgment call and not an easy one. If anybody tells you they're certain which choice is the right one, they're lying to you. Or maybe themselves.
Of course, it's also possible that Pelosi is doing this primarily to show the left that she tried--and that, at the end of the day, the votes for a strong public plan just are't there. I guess we'll see about that soon enough.
Update: My original item made this seem more black-and-white than it really is. There are certainly plenty of people on the inside who think this makes sense, just as there are plenty on the outside who don't. So I rewrote that sentence, with more appropriate qualifiers.