It seems to be "give up on the public option week" in segments of the blogosphere. Yglesias talks about the Public Option Pragmatists, with support from Steve Benen, using Chris Bowers sincere change of heart as the basis for giving up. Ezra climbs on board, and Josh Marshall continues the narrative he started on last week with this argument, saying that the White House, represented by Peter Orszag, is ready to give it up.
Earlier today I wrote about the political argument for continuing the fight for a public option--the importance of it for the majority of Democrats in Congress not to cave to the ConservaDems and risk losing power on every future policy fight, weakening the progressive populist movement at a time when it's most critical for the American people. Not to mention Dems' prospects in 2010 and 2012.
But there's also remains a compelling policy argument for the public option, even the less-than robust public option that the House passed last month. As a reminder, here's what the author of the public option wrote at the time about the House bill:
[W]e should keep in mind that the prime argument for the public plan has never been about a particular payment formula. It has been that a public insurance plan is vital as an institutional check on private plans, its role evolving to reflect the emerging weaknesses (or strengths) of regulated private competition. Put simply, health reform is much more likely to succeed with a public health insurance option, even one with negotiated rates, than if private insurers are left to run the show....
The same uncertainties surround the CBO’s prediction that the public plan will attract just one in five Americans within the health insurance exchange because of its higher projected premiums (down from earlier estimates of one in three)....Healthy people might choose the public plan because they will have the security of knowing that if they get sick or injured and need costly care, their plan will not be conjuring up ways to deny them needed coverage. (To be sure, if the private plans were required to be transparent about the services they covered and the rates they paid, it might be a different story. But the current congressional bills do little to require they disclose this data to enrollees.) And, of course, the more healthy people join the public plan, the more bargaining power the public plan will have and the more public plan rates will come down.
The public plan is also critical to reform as a cost and quality benchmark, one that is particularly crucial if private premiums accelerate upwards. The insurance industry has threatened that premiums will skyrocket if an individual mandate is not tough enough. It may be an idle threat, but if a final reform bill ends up looking more like the Senate Finance bill than the House bill, it might not be. In most local markets, competition is likely to be anemic, and regulation of insurers inadequate. There will be little to prevent insurers from raising rates as they have threatened.
.....
In short, it’s no time to be despondent about the fate of the public insurance option. For sure, pegging rates to Medicare and obligating Medicare providers to accept these rates would be far preferable, and a public plan with negotiated rates may do less to keep the insurers honest and drive down costs. But it’s still immensely valuable to give Americans an out--another choice--to let the insurers feel the heat of not being the only game in town. The fierce and continuing opposition of the insurance industry suggests that they think that a public option will prove a serious counterweight in an increasingly consolidated private market. The overwrought pessimism of the pundit class should not aid them in their cause of protecting themselves from a public-spirited competitor. [emphasis mine]
The public option remains central to reform, central to providing the competition and cost controls on the private insurers that neither of the bills fully achieve without it. Instead of arguing as Ezra does here, that the public option is becoming so watered down that "you'd be better off trading it away for something that's more meaningful," we should be arguing for finding a way to keep the public option meaningful, even if that means using muscular Senate tactics like reconciliation.
Ezra also argues that if we just give it up now, and the healthcare reform that passes isn't so great, it can get better.
I'd add to this that my read of the history is that social policy programs generally get better, rather than worse, over time. Right now, there are a lot of people who worry they'll lose something they have if health-care reform passes. But no one is currently receiving benefits from the plan. If it passes, however, then health-care reform develops its constituency, which has the power to protect its important provisions and expand where necessary. That's how Social Security grew, and Medicare, and Medicaid.
On the other hand, if health-care reform doesn't pass, the issue is probably dead for a decade, and if history is any indication, the next effort will be less ambitious, and less progressive. This bill, when it's finished, is not going to be very good. But it's going to be a lot better than what we have, and almost more importantly, a lot easier to improve in the future.
There are two points of argument as regards the public option in this. First, Ezra has said the public option is in danger of being so weakened that we might as well give up. But, as he says, social policy programs get better over time. There's no reason to believe that once a public option, once established, won't grow and improve over time. And, in fact, the possibility that this social policy improves over time is probably greater with the public option and a strong bill overall than if a bad bill passes.
He argues that if the overall bill doesn't pass, the issue will be dead for a decade. There's just as strong a danger that a weak bill passes, but Obama and the Congressional Dems call victory anyway, and declare healthcare reform accomplished, and we still end up with a "less ambitious, less progressive" bill. Because without the public option, and with the serious problems that still exist in the bills with both affordability and risk adjustment, this legislation is not that progressive.