On Sun, 15 Aug 2009, AP was cited to the effect that:
> http://www.google.com/hostednews/ap/article/ALeqM5jlMpJGn28kqCcgU-aGcYE_ZHW-ywD9A436580
>
> President Barack Obama's administration signaled on Sunday it is ready
> to abandon the idea of giving Americans the option of government-run
> health insurance as part of his ambitious health care proposal.
The unfortunate truth seems to be that even the strongest public option that has been on offer during this legislative debate wouldn't have made a damned bit of difference:
That's the theoretical side. The empirical evidence comes from MassCare, which has a public option which, on the current national legislative national spectrum, would be considered strong, and which doesn't work either to keep costs down or protect the poor. Steffie Woolhandler and David Himmelstein have written numerous articles on this. Doug's radio interview with Himmelstein a couple of months ago sums it up well:
http://www.leftbusinessobserver.com/Radio.html#090228
So giving it up isn't really any big thing. The public plan as germ of single payer -- the original Jacob Hacker idea, which was bruited about during the campaign -- was never on offer. It's inclusion or exclusion is irrelevant. At this point it's identity politics.
I think the best case a liberal could make for Obama's approach is the following:
Assumption 1: Single payer is currently impossible. Evidence: look how much the industry is fighting even this, which restricts them. The way they would fight against something which essentially expropriated them would a million times worse. And we'll clearly be lucky to pass this. So this is the edge of the possible. It might even be over the edge. It might well fail.
Assumption 2: The plan on offer will make an epochal change. It will establish health care as a right in a country that thinks in terms of rights. It was make it impossible for people to get dumped because of pre-existing conditions or because they get sick. It will make it a norm against which all future proposals will be judged that everyone should be covered.
Assumption 3: In a few years, this system will fail financially at both ends. The government won't be able to afford it, and individuals won't be able to afford it, and we'll be back in a state of crisis where a new systematic health care reform is necessary. But we'll be at a higher level precisely because fundamental rights, norms and expectations will have been established.
And by this next crisis, single payer will have had the next few years to continually drill its way into the public consciousness as the alternative. Already now it is way more widely known about and understood than it was during the Clinton debate. After several years of explaining how it is the only solution to the growing financial problems of Obamacare, it will quite probably be the only solution on offer, since all right wing critiques will be about tearing it down -- and people won't want to.
So the end result will be: the system will fail upwards. This reform is not only the best we can get now, it is a necessary precondition. Given the American political culture, getting to single payer has to be a two step process. We need to change reality to change consciousness -- and then we can use that changed consciousness to further change reality.
</end apologia>
I emphasize that this is a liberal defense, not a radical one -- and believe me, I know all the radical objections against as well as anyone.
But all I'm saying is: the public option fight is bunk. From an honest radical point of view, I think one has to admit that the only public option that would make any difference -- that one that has Hacker's original five indispensable conditions -- isn't on offer. And the others are just arguing over deck chairs.
Michael