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The fate of the public option

First, a few facts about the public option:

The public option is one of the most popular pieces of health care reform. A recent poll shows that in key states like Nevada, Illinois, Washington, Missouri, Virginia, Iowa, Minnesota, and Colorado clear majorities, sometimes as high as 68%, support the public option.  Michael Tomasky writes in the Guardian, “The results are basically in line with a raft of polling since this whole thing started. The public option is supported by majorities in virtually all blue and swing states, and even in a few reddish ones.”

The public option will save the government money, which means that it will save you, the taxpayer, money. According to the Congressional Budget Office, a public option that negotiates rates with providers will save the government $25 billion over ten years.  A strong public option that pays providers 5% more than Medicare rates would save even more money: $110 billion over ten years.

The public option will probably not be included in the final health reform bill. Wait, what?

On the surface, things have been looking up for the public option.  President Obama has said he supports it.  The House has already passed a version of the bill with it.  Democrats in the Senate look like they’re going to pass the final version through reconciliation, which means the public option doesn’t need a super-majority anymore.  All Democrats need to do then is:

  1. Find 50 Senators who will vote for the public option
  2. Get the House to pass the final bill

Unfortunately there’s a problem with each step.

In the Senate
Whether or not the public option has 50 votes is anyone’s guess.  Last week, Sen. Bernie Sanders said that he believes the public option does have 50 votes in the Senate, and was surprised President Obama didn’t include it in his proposal.  On the other hand, last Thursday Obama reportedly told House progressives that the public option doesn’t have the votes in the Senate.

It’s hard to say who’s right, because only a handful of Democratic Senators have actually come out opposing the public option.  Joe Lieberman of course is against it, and Blanche Lincoln of Arkansas is already running campaign ads saying that she has voted against it (and pretty much everything else in the past year), but other possible opponents are laying low.

Meanwhile, progressive groups have been trying to use process of elimination to find out which Democrats don’t support the public option.  They’ve launched the website WhipCongress.com which tallies the Senators who support it publicly, and so far they’ve identified 35 definite yes votes.   A few of the unknowns are almost certainly supporters (Russ Feingold, John Rockefeller, and Chris Dodd for instance), but that’s still a long way from 50.

Others have tried to make an educated guess.  Back in August, Nate Silver at the political stats blog FiveThirtyEight (which has an interesting story in its own right – check it out) identified 48 senators who were either very likely, or more likely than not, to vote yes for the public option.  He found another seven who might be convinced, but those included Blanche Lincoln and Republican Olympia Snow– both definite “no’s” now.  Even some of the “likely yes” votes are Senators from swing states and nervous about tackling health reform since the Massachusetts Senate election.

It’s possible that a big push from the White House could get 50 votes for the public option, but that’s far from certain.  Either way, the real problem for the public option lies in the House.

In the House of Representatives
Health care legislation originally passed in the House by only five votes (220-215).  Since then the bill has lost three supporters and two opponents (John Murtha died, the other four are retiring).  If everyone voted exactly the same as they did in the fall, that brings the margin of victory to only three (217-213).  Closer, but still enough to win.

However, Congressman Bart Stupak (D-Mich.) and Joseph Cao (R-Louis.) have both promised to vote against the final bill if it contains the Senate’s language on abortion.  There are probably at least ten others who would vote against the bill because of abortion– Stupak says more like 15 to 20.  Assuming the lower number, the bill would still fail by 20 votes, 205-225.

The Senate is unlikely to change its language on abortion, and might not be allowed to change it under reconciliation anyways.  In that case Nancy Pelosi will need to find some more votes if health care is going to pass in the House.  Only one non-retiring Democrat voted against the bill because it was too conservative: Dennis Kucinich (D-Ohio).  That one vote isn’t nearly enough to make up for all the possible abortion defectors.

Obama knows this and so, shortly after his meeting with House Progressives on Thursday, he met with the leadership of the New Democrat Coalition, aka the Blue Dogs.  Some of the Blue Dogs have signaled that with the modifications made by Obama and the Senate, they could support the final bill.  As Neera Tanden of the New Republic writes:

In fact, the Senate bill, even after the president’s proposed modifications, addresses almost all of the major concerns that the Blue Dogs have raised. As a matter of policy, the Senate bill is a moderate Democrat’s dream.

They might support the Senate bill, but it’s almost certain that none of them will vote for any health reform bill that contains a public option.

[For more details on the unfolding drama in the House, check out this article by Slate magazine’s Timothy Noah.]

What Now?
Unfortunately, despite its popularity with the American people, the public option is still considered controversial in Congress.  And with such narrow margins for passing any kind of health care reform, President Obama isn’t going to push for it… at least this time around.

The public option may be down but it’s not out.
According to Raul Grijalva (D-AZ), in his meeting with progressives Obama said he was “personally commited” to pursuing the public option once the reform bill becomes law.  Public option supporters are nothing if not persistent.  Even if it doesn’t make it into the final bill, that surely won’t be the end of it.

{ 2 comments… add one }
  • lululee March 9, 2010, 10:33 am

    The crime of Medicare fraud is bigger than the drug business in total volume.


  • John Nagle March 10, 2010, 9:31 am

    As a persistent public option supporter, this is depressing ‘realpolitic’. Supporters should remain vocal, however. If we capitulate too soon, then the blue dogs will find some other issue, like the abortion issue, to demand further ‘compromises’.
    Nevertheless, I wish that the Democratic party would impose discipline on minorities within the party. Republicans have done so to their advantage, although to the country’s disadvantage. It is an unfortunate race to the bottom, but the Republicans are winning by going to the bottom fastest. Obama has to stop playing nice if anything is to get passed.

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