Legal Commentary

Why Did Progressives Support A Public Option?

By Big Tent Democrat

(See also Norman Solomon.) And when I say progressives, I do not mean Ezra Klein. Here is an example of progressive post-loss rationalization from Daily Kos:

True, we did not get a public option, but we are going to get a health insurance reform bill that covers virtually every American citizen and puts in place a patients bill of rights on steroids. It's not perfect: outside of Medicare, the middle-class will be entirely dependent on a system of for-profit medicine [. . .] But even though the bill is not perfect, for the first time in our nation's history we will have enshrined into law the notion that everybody ought to have health insurance -- and that's a major accomplishment.

When Lewison says universal health insurance coverage, he is referring to the individual mandate that requires all citizens to have insurance, but does not offer all citizens a public insurance option. That, we are to believe, is the great progressive accomplishment. I respectfully demur. There was a reasoned basis for believing a public insurance program was essential to real health reform. There was a real difference of opinion about that point in Democratic circles. Last December, Ed Kilgore articulately described this divergence of view:

This approach was inherently flawed to "single-payer" advocates on the left, who strongly believe that private for-profit health insurers are the main problem in the U.S. health care system. The difference was for a long time papered over by the cleverly devised "public option," which was acceptable to many New Democrat types as a way of ensuring robust competition among private insurers, and which became crucial to single-payer advocates who viewed it as a way to gradually introduce a superior, publicly-operated form of health insurance to those not covered by existing public programs like Medicare and Medicaid. (That's why the effort to substitute a Medicare buy-in for the public option, which Joe Lieberman killed this week, received such a strong positive response from many progressives whose ultimate goal is an expansion of Medicare-style coverage to all Americans).

Now that the public option compromise is apparently no longer on the table, and there's no Medicare buy-in to offer single-payer advocates an alternative path to the kind of system they favor, it's hardly surprising that some progressives have gone into open opposition[ . . .]

Lewison seems to have no idea why progressives focused on the public option as an essential element of health care reform and that the total defeat of the concept in the current health bills is precisely why the political bargaining by progressives was an abject failure.

It appears that many progressives of Lewison's stripe simply do not understand why the public option was essential to the progressive vision of health care reform. Perhaps to them the public option was just some type of symbol. But for serious progressive health care reform advocates, the public option was THE essential element of health care reform because it would be the linchpin to future reform that accomplished progressive goals.

There is a reason why the Medicaid expansion component of the health bills is undoubtedly in tune with the progressive vision of health care reform -- it involved expanding health insurance to the less well off through a public insurance program.

Moving away from the for-profit health insurance system that currently strangles our health systems is the key element of the progressive vision for health care reform. The complete defeat of that vision in the current health bills is precisely why political bargaining by progressives on these issues must be considered an abject failure.

Unless, progressives really do not believe the things they said last year about the essential nature of including public insurance reform in any health care reform proposal. In which case, carry on with the Victory Parade.

Speaking for me only

Full post as published by TalkLeft on March 18, 2010 (boomark / email).