Will People-Power Defeat the Insurance Lobby This Time Around?

In spite of the best efforts of the insurance industry and their followers in Congress and the media, it is still very possible that the health reform bill passed by Congress will include a robust public plan. This is a case where the simple facts and persistent grassroots pressure may overcome the political power of a major industry.

If the bill passes with a serious public plan, it could make an enormous difference for the future of health care in the United States. However, the fact that the public option is even on the table at this point, after all the political experts had counted it out, shows the enormous potential for popular pressure to influence policy debates in this country.

The basic story is that President Obama and the Democratic leadership in Congress had always been lukewarm in their support of a public plan. President Obama had included it in his original proposal, but has made it clear on numerous occasions that he did not view it as an essential part of his health care plan.

Of course, that is not the way that presidents get measures passed that they really want. President Clinton never said that he didn't view NAFTA as being a big part of his trade policy. President Bush didn't say that Congressional authorization of the Iraq war was a relatively small matter in his larger foreign policy agenda. President Obama's statements, that a public option was not essential, were an invitation to Congress to give him a bill that did not include a public plan.

This could have been the end of the story for a public plan, except for the determined efforts of progressive activists to insist that Congress include a public plan. While the plan's opponents argued that the leadership did not have the 60 votes needed in the Senate to end a filibuster, public plan supporters pointed out that public plan opponents did not have the 218 votes needed in the House to get a health care plan approved without a public option. The logic was simple, if progressive members in the House refused to back a health care bill without a public plan, then any health care bill that passes Congress would have to include a public option. A large coalition of progressive groups kept up the pressure, insisting that Democrats in the House insist that any bill include a public option. They bombarded members with phone calls, faxes, emails and staged protests and organized petitions. This coalition was helped by polls that consistently show a large majority of the public support giving people the option to join a Medicare-type public plan. In fact, a recent New York Times poll showed people supporting a public option by a margin of 65 to 26 percent. The same poll showed that overall health care reform package losing by a small margin.

Supporters of a public plan have also been helped by the facts. The Congressional Budget Office's analysis shows that a robust public plan, with rates tied to Medicare rates, can save $100 billion over the next decade. This is a substantial portion of the money needed to cover the cost of the health care bill. Given the popular support for a public plan and the evidence that it could save substantial amounts of money, it is clear that opponents of a public option are not responding to constituents or concerns over costs.

The sustained pressure from progressives seems to have firmed support for a public plan in the House, but there is still the issue of getting 60 votes in the Senate. Here, it is important to make a distinction that the media and political pundits have tried to hide. It is not necessary to get 60 senators who will support a public plan. It is necessary to get 60 senators who will allow the Senate to vote on a public plan. This is very different.