The Treatment

What Public Option Supporters Won

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The public option is dead this morning. And this time, it isn't coming back to life. The Senate isn't going to include any version of the idea in its bill. And while the House can still demand a public option in conference, nobody I know expects the House to prevail.

The primary causes of death were the fierce opposition of special interests and the institutional habits of the United States Senate, in which a clear majority of senators representing an even clearer majority of the people lack the power to pass a bill. The time of death? Somewhere around 6:30 p.m. last night, during a meeting of the Democratic caucus, in which Majority Leader Harry Reid announced that the votes for a public option just weren't there--and that passing a health care reform bill, as quickly as possible, was too important to risk further debate and delay.

After the meeting, even stalwart public option defenders like Sherrod Brown and Jay Rockefeller signaled their grudging agreement. And that's because they knew Reid was right. The Majority Leader had spent most of the last month trying to round up the votes for a public option and, when the votes weren't there, he put negotiators in a room to come up with an acceptable compromise. They did, only it still wasn't acceptable enough for Senator Joe Lieberman. And without Lieberman, the Democrats couldn't move forward, at least not without great risk to the broader project. At the end of the day, Brown and Rockefeller and their allies simply care too much about people struggling with their medical bills--people who would still benefit, clearly, from reform without a public option--to mount further resistance. Lieberman, by all appearances, felt no compunction to put people over pique. That's why he won.

Disappointed progressives may be wondering whether their efforts were a waste. They most decidedly were not. The campaign for the public option pushed the entire debate to the left--and, to use a military metaphor, it diverted enemy fire away from the rest of the bill. If Lieberman and his allies didn't have the public option to attack, they would have tried to gut the subsidies, the exchanges, or some other key element. They would have hacked away at the bill, until it left more people uninsured and more people under-insured. The public option is the reason that didn't happen.

And if public option supporters lost in the Congress, they won in the country as a whole. The underlying political problem for liberals remains what it has been for a generation: profound and widespread distrust of government. But polls consistently showed voters thought the public option advocates were right--that, at least when it comes to health insurance, government can be trusted. It was a small victory, but it's on top of such small victories that political movements are built. Someday in the future, that movement may be powerful enough to win more sweeping changes. Who knows, maybe those changes will include a government-run insurance plan.

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