The public option: our line in the sand

Once upon a time, the public insurance was just the public insurance option: a means to provide low-cost, high-quality health care to tens of millions of Americans and drive down private insurance costs at the same time. No longer. Now the public insurance option has a new role: the Battle for America’s Soul.

How did a good piece of public policy transform into the first great political battle of Obama’s presidency? Good question, and the odd thing — you might call it ironic, but it’s probably to early to make that determination — is that it is the opponents of the public option who have transformed it from a vital-but-optional element of health care reform to the one thing that must be in the final bill.

A line in the sand.

In terms of policy, a public insurance option was always going to be the best way to counter the runaway costs of private insurance. A health care option that had no profit component and did not include fee-for-service, an option that measured the health of customers and not profits delivered to investors; of all the ways suggested to accomplish cost-reduction, the public option had the advantage on almost every other policy alternative.

But it didn’t have to be the final choice. With bipartisan (a stupid, inaccurate word) discussion and examination of the entire health care issue, other alternatives could have been found. Clever people seeking creative solutions to drastic problems can do amazing things. But everyone involved in the process has to be determined to find those creative solutions, and the opponents of health care reform had no such mindset.

They just want to stop the whole thing cold.

So there has been no creative, positive examination of the alternatives. Baucus has spent several months bent over and asking Grassley if his bottom-side is sufficient pleasing to earn Chuck’s arousal. The Blue Dogs have obediently done their insurance industry masters’ bidding and moved to block the public option, causing the Progressive Caucus to threaten to vote against any bill without the option. Non-solutions like coops have been trotted out by Dems like Conrad who seem not to care about the need to pass real reform — or support his president and party.

Then there is the PR campaign.

Oh sweet mercy. If the health insurance industry and their allies want real reform, they wouldn’t pull this shit. As Wendell Potter, former insurance industry PR flak told a rally in downtown Portland on Saturday, the only thing that would appeal more to the insurance industry and their Wall Street investors than killing reform would be to shape a reform that increased profitability of private insurance. Republicans in the Senate, led by the Grassley and Enzi, who are allegedly negotiating with Baucus for a “bipartisan” solution, have revealed that they are probably not going to vote for any reform bill.

The focus of attack on the entire reform process is the public option. “No government control” of health care is the mantra, if it’s still a mantra when screamed over and over rather than chanted to achieve bliss. When Medicare is held up as a shining example of how well “government-controlled” health care can work (and it does), the impending — ie, future; ie, not yet actually happened so can be avoided — funding crisis is thrown up as an attack. The myths of long lines in England and months to wait for a life-saving surgery in Canada are given as “proofs” of the failure, and worse, of government-run health care.

It is, of course, no accident that these attack campaigns confuse the public option and single-payer systems. A successful public insurance option will be seen by many as demonstrable proof that single-payer is both superior and viable. A successful public option could well spell the end of private insurance if the American people realize the superior nature of single-payer. So even though a public option is not the same as single-payer, it is the gateway drug to same and, therefore, attacked as if passage of a bill that includes a strong public option means the destruction of health care provision in the country as we now know it.

Except that is the goal: the destruction of health care provision in the country as we now know it. The current system is so far beyond broke,, even opponents of reform cannot deny that fact. For them, however, the alternative is worse. “Alternative” for reform opponents is not, however, a broken system of health care but the loss of millions — tens of millions — of dollars in insurance industry campaign donations. There is no massive teat of gigantic monies contained within the public insurance option. The public option will only provide quality, affordable health care to tens of millions of Americans, not big campaign donations to tens of American Senators.

The end results of a public option are crystal clear to the insurance industry, their investors and their Congressional minions. They have made killing the public option their #1 priority, and so, rather than working to find a good alternative that would provide quality, affordable health care to tens of millions of Americans, they are simply trying to kill the reform effort by sinking the public option and taking the whole bill down with it.

This is why passing a strong public option has become so important: Not just because it is the best policy solution (it is) but because those who will oppose the entire progressive agenda — health care reform, climate change, environment, economy, education, voting rights, net neutrality, and all the rest — have made it the defining battle. If we lose the battle over the public option, we lose the health care reform battle and everything else is in jeopardy. Obama will transform from a shining hope for a better future to the first Jimmy Carter of the new century. His ability to pass any meaningful reform on any other front will be significantly threatened. The Democrats will lose seats in the 2010 election, and the downward spiral will continue. Obama will be challenged in the 2012 primaries, and the Republicans may even stand a chance of winning back the White House.

The public option may be damn good public policy, but in terms of the future of our country and the vision for it shared by many progressives (and many others more centrally aligned), the public option is far more.

It is our line in the sand. We dare not fail.