All due respect to a guy who got his start reading this very blog, but Ezra, are you high? Of course the Public Option is at the center of all this!"[E]ven if getting any bill called 'health care reform' passed would be good short-term politics," writes political scientist Scott Lemieux, "it's worth further emphasizing that signing a bill without (at a minimum) a public option would be a substantive disaster." Elsewhere, he says, "the public option is the core of the reform; a Blue Dog bill isn't so much half a loaf as a few meaningless crumbs." And, finally, "a bad bill would be worse than no bill."
The public option, as it exists in any bill moving through Congress, is not the core of reform, nor anything near it. It is, for one thing, limited to the Americans who buy into the Health Insurance Exchanges, and the exchanges are in turn limited to the unemployed, the self-employed and small businesses. In the House bill -- which is the strongest of the bills -- the Congressional Budget Office estimates that 27 million Americans would be in the exchanges by 2019. That's not nothing, but it's not much. Imagine half choose the public option (CBO estimates many fewer than that). You now have 13.5 million Americans in a public insurer with no substantive advantages over private insurance. That's not a gamechanger, it's a tweak.
But it's also worth offering a more general reality check here: The public option is not now, and has not ever, been the core of the argument for heath-care reform. It is the core of the fight in Washington, D.C. It is an important policy experiment. But it was not in Howard Dean or John Kerry or Dick Gephardt's plans, and reformers supported those. It was not in Bill Clinton's proposal, and most lament the death of that. It is not what politicians were using in their speeches five years ago. It is a recent addition to the debate, and a good one. But it is not the reason were are having this debate.
Rather, what has kept health-care reform at the forefront of liberal politics for decades is moral outrage that 47 million of our friends and neighbors are uninsured. That medical costs are one of the leading causes of bankruptcy in the United States. That an unemployed machinist gets screwed by fly-by-night insurance schemes while a comfortably employed banker need never worry. That the working class ends up in emergency rooms with crushing chest pains because they didn't have health insurance and didn't get prescribed cheap blood pressure medications five years before.
Without the public option—unless you strip out the mandates too—this whole thing becomes a bill that forces people to give money to the insurance companies! It's a gigantic handout of economic rents to the very actors who provoked the reform in the first place, and would ensure that so much insurance industry money floods into Washington that any and every attempt regulation would be made toothless within picoseconds!
And since when is it all just about the uninsured? It's not just the uninsured that is the problem. It's the underinsured: the people who can't choose their doctors, can't get the treatment they needed, and can't afford the immense co-payments for those procedures that they're lucky enough to actually get covered. I'm pretty sure that most liberals think about those people quite a bit. I imagine that a lot of liberals have been those people.
Why would Ezra, of all people, mischaracterize their concerns?
Yes, you could rationally argue—as Ezra did—that "[i]f reformers cannot pass a strong health-care reform bill now, there is no reason to believe they will be able to do it later." But what's being proposed isn't a strong bill. This isn't even a weak bill. It's billion-dollar pork to the real constituents of all those paid-for Democrats out there that might as well have"D-Insurance" next to their name.
And, sorry, but they damned well don't deserve it.
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