The President, Progressives and the Myth of the Robust Public Option

by BAR managing editor Bruce Dixon

The good news is that progressives in Congress are insisting on a "robust public option" in any health care legislation that will drive down coverage prices and be available to anybody who wants it.  The bad news is that they knew insurance lobbyists and the president's negotiators had crippled the public option months ago and remained silent until public dissatisfaction made them speak up.  Why didn't they fight for their "robust public option" in May and June, when it might have actually been written into the bill?  And how can they portray the public option an appropriate negotiating fallback from single payer when they never fought very hard to put it on the table in the first place? 

The President, Progressives and the Myth of the "Robust Public Option"

by BAR managing editor Bruce Dixon

There are three problems with the insistence of House progressives that a "robust public option" be part of any health care reform package.  

Problem Number 1:  the demand for a "robust public option" comes awfully late.

Jacob Hatcher's original, expansive vision of a public option was a plan that would use low prices and the absence of predatory practices like recission (revoking policies whenever peole actually get sick or inured) to attract 120 million policyholders away from private insurers and combine them in the same risk pool as the tens of millions currently uninsured to negotiate with drug companies and compete with private insurers, thus driving the cost of health care down.  But House progressives knew or should have known as early as May that the public option provisions in all House versions of the president's bill had been so crippled and and circumscribed into impotence that the Congressional Budget Office estimated only 10 million policyholders of private insurance companies would find it a better bargain than the inadequate, often revoked and always overpriced insurance they already have.  

So the first problem with the progressive demand for a "robust public option" comes awfully late in the game, perhaps too late to be taken seriously.  Coming as late as it does, the progressive demand looks more like a defensive move to insulate them against a president who is now fighting against his own campaign promises, which millions, including his most avid supporters understood to include fighting to enact some form of universal health care in his first term.  The president after all, doesn't run for re-election till 2012.  The House stands for election every two years, and if voters are deeply enough displeased with the White House, they will punish House Democrats first.

Evidently, House progressives were counting on the president to lead, and to keep his promises, and imagined that all they needed to do was be good and faithful followers, rather than leaders in their own right.  They really should have known better.

At this late date, House progressives seem to have only the power to stop the president's very bad health insurance "reform," not to rewrite it or propose their own.  Whether they have the nerve to use this power is another question altogether.

Problem Number 2: has anybody actually written a "robust public option" into any legislation?

As far as we know, the answer is no.  There have been plenty of glowing descriptions, though.  So the "robust public option" is not so much a concrete proposal, like HR 676, the Enhanced Medicare For All single payer, as it is a kind of advertising slogan.  It is very hard to see how the labyrinthine legislative processes can accommodate a major rewrite of this year's health care reform bill -- or in the president's language, health insurance reform, at this late date.  

The strength of an advertising slogan is that you can believe whatever you want or need to believe it is, and convince others to do the same.  If right wingers are calling single payer socialistic and un-American you can counter that your vague and undefined public option is "uniquely American."  Who can disprove that?  

You can tell people who believe the myth that capitalism is good and thrives on competition - a myth because capitalists tend to want government protected monopolies which jack up profits rather than competition which drives down profits, you can say your imaginary robust public option will provide that competition.  

And for the majority of the American, and the vast majority of people who knocked on doors, volunteered, sent emails and registered voters for change in 2008, the folks who overwhelmingly favor some form of Medicare For All, you can claim your imaginary "robust public option" is the next best thing to what people really want,  a realistic compromise, an honest negotiating fallback from single payer, which brings us to the third problem.

But the weakness of an advertising slogan is the same as its strength.  If it can mean whatever the believers believe, it can also mean whatever the haters hate.  Insurance companies, Big Pharma, right wingers of all stripes hate Medicare For All, for which the "robust public option" is presented as a stand-in.  Thus you can hardly blame the opponents of Medicare For All for fighting against your "robust public option" just as hard as they would fight real single payer legislation, and for using all the arguments they would use against real single payer --- it's too much reform too fast, it will cost too much, it will drive private insurance out of business, it will get between patients and doctors, and so on.  But the fact that the "robust public option" is not yet written into any specific legislation makes it hard to defend.  

Doubling the difficulty of defending the public option as part of the president's bill is the fact that all the best answers to the right wing rhetoric are either arguments for single payer itself.  HR 676 would create a net 2.6 million new jobs, and eliminate a major cause of two thirds of the nation's personal bankrupticies.  It would free up the third of every health care dollar that now goes to an insurance company, and President Lyndon Johnson cranked up Medicare within eleven months of signing the bill.  None of these arguments can be mustered to defend the "pubic option," component of the administration's bill because the legislation in its totality fails all of these tests.  It preserves the profit margins of insurance companies by requiring millions of Americans to purchase inadequate insurance at their own expense, and by providing taxpayer subsidies for millions of the poorest to purchase these same worthless product.

Problem Number 3: the public option was never a negotiating fallback from Medicare For All, HR 676.

The "robust public option" is not and never was, as many progressives have claimed, a negotiating fall-back, a next-best-option to the single payer, Medicare For All, everybody-in-nobody-out solution that polls show a majority of Americans have favored for years now.  For the public option to be a negotiating fall-back from single payer, single payer would actually have to have been on that negotiating table in the first place.  It never was.  The interests of private insurance companies were taken care of before the first committee met, even before the election, when candidate Obama took on as advisors many of the team that enacted RomneyCare in Massachusetts.  Way back in January of 2007, Black Agenda Report told you that the Massachusetts model of the "individual mandate," requiring ordinary citizens to buy health insurance under penalty of law, the same as they are required to buy car insurance, would be the centerpiece of the Obama health care plan.

Despite the campaign rhetoric and the wishes of the Democratic base, the fix was in quite early.  There have been no good faith negotiations at which the real interests of the American people, the real favored plan among the American people, everybody-in-nobody-out Medicare For All has even been allowed to be represented.  Nancy Pelosi and the House leadership had to have their necks twisted to agree on allowing a floor vote on HR 676, the Enhanced Medicare For All act, and to let a provision into the president's awful legislation which lets states enact single payer on their own if they so choose, concessions that nobody doubts will be withdrawn if resolve weakens on the part of the progressive caucus.

In the end, the White House, like the predatory employer bargaining down the wage of a job applicant, is not on our side.  It aims to figure out the least the American people will accept in the name of health care, or rather health insurance reform, and claim that's what's contained in whatever bill it signs into law this term, just to get the issue off the table.  The job applicant was unemployed yesterday and should be grateful that she may have a job tomorrow.  We too should be properly grateful for whatever our president chooses to bestow upon us.

Can he get away with it it?  Well, the president doesn't run again till 2012, and the uninsured, under his various proposals, won't be covered till 2013.  The White House has plenty of time.  Bill Clinton gave us NAFTA in his first term with a minority of Democrats and a solid Republican vote, and even though he lost Congress the following year survived for a second term and left office high in the polls.  Slick Wille got away with it.  Why shouldn't Obama think he can do the same?

But Democrats, both progressives and the House leadership are looking at the parallels between 2009-2010 and 1993-94.  It's a drama they are not anxious to repeat.  But their noise about a public option, robust or otherwise, is awfully little and comes awfully late.

Bruce A. Dixon is managing editor at Black Agenda Report and based in Atlanta GA.  He can be reached at bruce.dixon(at)