The “public option” and the wheelbarrow parable: Part 3
By Kip Sullivan, JD
In the second part of this three-part series, I reviewed the evidence indicating the “public option” campaign as well as “option” proponents in Congress refused to adopt criteria that would have guaranteed that the “option” would be large enough to survive competition with the behemoths that dominate America’s highly concentrated insurance industry. This failure to articulate a clear vision of what it would take to ensure large size in the “option” was the first indication that the “option” campaign gave higher priority to an insurance industry bailout than the “option.”
In this part – Part 3 of a three-part series – I review the second type of evidence that indicates the “option” campaign’s highest priority to date has been a bailout for Aetna et al. The evidence I review in this part indicates the “option” campaign never made the “option” a precondition for its support of the Democrats’ “reform” bill, and that even after the Senate passed a bill with no “option” in it the “option” campaign’s leaders (with perhaps the sole and fleeting exceptions of Howard Dean and Moveon.org) continued to support the Senate bill.
No demand that the “option” be included in the final bill
The “option” campaign’s failure to insist that the Democrats’ “option” meet Jacob Hacker’s original criteria (or any other meaningful criteria for that matter), and their willingness to exaggerate the damage the Democrats’ little “option” would do to the insurance industry, were not the only signs that they cared more about the bailout than the “option.” In the final months of 2009 it became clear “option” proponents were not going to make inclusion of an “option” a precondition of their support for the Democrats’ “reform” bills. In short, it became clear “option” leaders couldn’t bring themselves to oppose what even they knew was an unadulterated insurance industry bailout.
This became increasingly obvious in the weeks after September 16 when Senator Max Baucus (D-MT), chair of the Senate Finance Committee, made it official that he would not include an “option” in his bill. “Option” advocates mounted a well-funded publicity campaign throughout the fall and early winter to urge Baucus, Senate Majority Leader Harry Reid and other Senate leaders to include an “option” in the final bill. But at no time – not even after the Senate passed a bill on Christmas Eve without an “option” – did leaders of the “option” campaign tell Democrats they were fed up and would oppose any bill without an “option.”
There were some rare exceptions, notably Howard Dean’s Democracy for America and Moveon.org (both organizations are members of Health Care for America Now). Dean spent a few days in December urging universal coverage advocates to oppose the Senate bill (see, for example, Dean’s December 16 comment on Vermont public radio and his December 17 op-ed in the Washington Post). But despite Dean’s encouragement, HCAN and HCAN member-organizations like the AFL-CIO, SEIU, AFSCME, Planned Parenthood Federation, and ACORN refused to do anything to stop the insurance industry bailout. Many of these organizations severely criticized the bill for not having an “option,” for including a “Cadillac tax,” for restricting the right to an abortion, etc. But none urged a no vote on the ground that the “option” had been stricken from the bill.
In fact, they did the reverse. They urged their followers to support the bill. Hacker led the charge just days after Dr. Dean’s Washington Post op-ed. In a piece published in the Huffington Post on December 20 entitled “Why I still believe in this bill,” Hacker wrote:
Now that the core demand of progressives has been removed from the Senate health care bill – namely, the public health insurance option – should progressives continue to support the effort? …. It would … be tempting for me to side with Howard Dean and other progressive critics who say that health care reform should now be killed. It would be tempting, but it would be wrong.
On December 15, HCAN’s blogger Jason Rosenbaum wrote: “I’d say there’s no question that Health Care for America Now believes the Senate bill doesn’t conform to our principles for reform…” But on December 24, the day the Senate passed its “option”-less bill, HCAN’s campaign director Richard Kirsch hailed the bill as “one big step closer to comprehensive health care reform.” And SEIU President Andy Stern declared, “Make no mistake about it, for working Americans this vote signals progress.”
The “option” campaign’s disinterest in promoting a large “option” (see Part 2), its failure to make even the weak version of the “option” a precondition for its support of the bailout, and its explicit support for the Senate bill are not the only indications the “option” campaign supports a bailout with or without an “option.” The campaign continues to promote slogans designed to drum up support for generic “reform” bills regardless of whether they contain an “option.” For example, Moveon.org has urged the public to “pass Obama’s health care plan” and for the last several weeks HCAN leaders have urged their followers to tell Congress to “get the job done.” On March 9, HCAN sponsored a rally outside a meeting of America’s Health Insurance Plans at which they promoted the false message that the insurance industry is scheming to oppose the bailout HCAN has worked so hard for. As HCAN’s Rosenbaum put it on the HCAN blog, the message of the rally participants was: “We need Congress to listen to us and not the insurance companies. We need to pass real reform now.” Demanding “real reform” is quite different from, “We want a ‘public option’ and we will not support a bailout bill that does not contain an ‘option.’”
Advocates within Congress almost as wishy-washy
Unlike Hacker and HCAN, some “option” advocates within Congress actually threatened to oppose legislation that did not contain the Democrats’ mouse version of the “option.” This happened more often in the House than the Senate. Throughout the spring, summer and fall of 2009, the Congressional Progressive Caucus (which represents 79 Democrats in the House) repeatedly stated that the “option” should be included in the final House bill. They even said on a few occasions their members would vote against a bill that contained no “option.” For example, on June 8 CPC co-chair Representative Raul Grijalva posted a press release on behalf of the CPC that read, “On April 2, the CPC sent a letter to Speaker Nancy Pelosi and Senate Majority Leader Harry Reid stating that a majority of its members would oppose any legislation that did not include a public option.”
Similarly, on September 3, 2009 the CPC sent President Obama a letter in which they rattled their swords once again for what they deemed to be a “robust public option” (which in “optionese” means a tiny “option” blessed by Congress with the meaningless authority to use Medicare’s rates plus 5 percent). “We continue to support the robust public option … and will not vote for a weakened bill on the House Floor or returning from a Conference with the Senate. Any bill that does not provide, at a minimum, a public option built on the Medicare provider system and with reimbursement based on Medicare rates — not negotiated rates — is unacceptable.”
However, when push came to shove, the CPC’s threat turned out to be meaningless bluster. The bill that ultimately passed the House in November did contain a little “option” but not the “robust” version (one authorized to use Medicare rates) the CPC said it had to have. According to Salon, only two CPC members (Representatives Eric Massa, who just resigned from Congress, and Dennis Kucinich) voted against the House bill. And now that President Obama is proposing a compromise bill with no “option” at all in it, the CPC is apparently abandoning even a “less than robust option.” Salon recently reported that Representative Grijalva hinted that he and his CPC colleagues would vote for the insurance industry bailout without the “public option” because, at a March 4 meeting with CPC members, Obama promised to work for an “option” in the future.
Senator Jay Rockefeller appears to be the only “option” proponent within the Senate who stated publicly he would withhold his vote for the “reform” bill if it did not contain an “option.” But Rockefeller soon retracted his threat. Today Rockefeller, like Hacker, argues against adding an “option” to the Democrats’ bailout bill. The failure of HCAN and its member organizations to adopt a similar position may have had something to do with Rockefeller’s about-face.
When did the bailout become the highest priority?
The press release published by HCAN on July 8, 2008, which announced HCAN’s formation, offered this semi-stirring explanation of its mission:
Health Care for America Now offers a bold new vision for health care reform: Americans can keep the private insurance they have, join a new private insurance plan, or choose a public health insurance plan.
Imagine how much less stirring this “vision” would have been if HCAN had announced the position it holds today. The press release would have gone something like this:
HCAN offers a bold new vision: Ten percent of Americans will be given the opportunity to enroll in a public health insurance plan, the other 90 percent will be forced to buy health insurance from the insurance industry, and the taxpayer will be asked to fork over half-a-trillion dollars per decade to the insurance industry. HCAN will not go to the mat for the tiny public program. If necessary, HCAN will jettison the little public program and throw their full support behind an insurance industry bailout. It is more important to HCAN that the insurance industry get millions of new customers and its half-trillion from the taxpayer than it is to enact any form of a public health insurance plan.
Obviously, if HCAN had enunciated this “vision” in July 2008, they would have turned off a sizable chunk of the universal coverage movement. They did not do that. They promised instead a huge public program that would be available to all Americans (they heaped straw in the proverbial wheelbarrow). Jacob Hacker adopted the same tactic.
It was obvious as early as last June when the Democrats introduced their moribund version of the “option” that this tactic had failed. With the failure of the Senate to include even the moribund “option” in the bill it passed on Christmas Eve, with the election of Scott Brown in Massachusetts in January, and with Obama’s refusal to include an “option” in the legislation he announced on February 22, it seems safe to say that what was a moribund “option” has become a dead “option.” However, a naked bailout of the insurance industry – a bailout without even the fig leaf of a little “option” pasted over it – remains a real possibility.
Is this what the “option” campaign wants? Given the campaign’s record, one would have to say it is. It may not always have been so. It is possible that two years ago most of the campaign’s leadership sincerely viewed a bailout as no more important than an “option.” But whatever the campaign leadership’s original motivation might have been, the record shows that at some point, no later than 2009, a bailout became their highest priority and the “option” became a lower priority. The record also indicates that HCAN et al. engaged in deception to conceal this fact.
For the record I would like to stress once again that my objection to the “option” is not that the “option” itself will waste tax dollars, enrich the insurance industry (the country’s most powerful opponent of single-payer legislation), retard the universal coverage movement, and threaten to snuff out the state-level single-payer movement. All those dire consequences flow from the insurance industry bailout – the mandate and the subsidies – not from the little “option,” at least not directly. My primary objection to the “option” is the role it has played in facilitating enactment of the bailout. It has played the role of the straw in the wheelbarrow parable. It has allowed the “option” campaign to turn itself into a campaign for an insurance industry bailout — right under our noses.
Kip Sullivan is a member of the steering committee of the Minnesota chapter of Physicians for a National Health Program. He is the author of The Health Care Mess: How We Got Into It and How We’ll Get Out of It (AuthorHouse, 2006).