Competing measures, one focus

COMPETING MEASURES, ONE FOCUS…. For several months, the vast majority of the health care wonks I can think of have downplayed the significance of the public option in the reform debate. Most seem to like the idea, and think it’s worthwhile, but nearly all believe there are other provisions that will prove more important in the grand scheme of things.

It led Ezra Klein to ask a good question: how constructive has the debate over the public option been to the larger reform effort?

The case against goes something like this: The success of the plan is going to depend much more on adequate subsidies than any of the public option compromises on the table, and letting all the energy go into the public option has left fairly little organizing capacity for things like tax credits for people making between 300 and 400 percent of poverty. The liberal obsession with the public option — and not even a very strong public option! — has distracted them from these more important policies, making it more likely that they’ll fall a bit short of where they otherwise could be.

The case for goes something like this: The success of the plan is going to depend much more on adequate subsidies and the individual mandate than on any of the public option compromises on the table, and diverting all of the conservative base’s energy into fighting around the margins of the public option has left them with fairly little organizing capacity to go after the revenues or the mandate or the total cost of the bill. The conservative obsession with the public option — and not even a very strong public option! — has distracted them from these more important issues, making it more likely that health-care reform survives with its basic structure intact.

Ezra sides with the latter, and I agree. In fact, I’ve often wondered if Republicans and other conservative opponents of reform made a tactical decision by focusing so much of their energies on fighting tooth and nail against the public option.

It’s common to hear media complaints that the left has become overly invested in the notion of public-private competition, but what often goes overlooked is the fact that the right has invested considerably in fighting against a public option (which they think will lead to competition, which will lead to insurers failing, which will lead to a Medicare-for-all-like system, which will lead to communism, which will lead to rifts in the space-time continuum).

But looking back over the last several months, we see that reform opponents a) went after the single most popular element of the reform plan; and b) largely ignored contentious provisions that may have been vulnerable to attacks from the right.

Now, it’s certainly possible that the public option, or some compromise version of it, will be scuttled in the end. I sincerely hope that’s not the case — there’s no reason in the world for the measure to be removed from either bill — but time will tell.

Putting that aside, however, has the debate itself been constructive? Absolutely. It’s positioned reformers as advocates of increased choice and competition; it’s kept Republicans arguing against a measure that most Americans like; and it’s kept conservatives busy and away from other, potentially-damaging fights.