Crunch Time for the Public Option

When Barack Obama assumed the presidency, there was talk that former Democratic National Committee chair Howard Dean might be his Secretary of Health and Human Services. 

That would have made Dean the administration's point-person in the fight for health-care reform. It also would have increased the likelihood that reform would be real. But Dean was rejected. And, now, the prospect of real reform is fading fast.

Dean said last week at the "Netroots Nation" gathering in Pittsburgh that the only thing that made health-reform legislation proposed by House committees (and apparently backed by the administration) worth doing was the public option. In that legislation, the physician and former Vermont governor argued, "the last shred of reform is the public option."

Just days later, however, the administration appeared to be shredding that last shred of reform. The Associated Press reports that, "President Barack Obama's administration signaled Sunday it is ready to abandon the idea of giving Americans the option of government-run insurance as part of a new health care system."

The woman who got the HHS job reform advocates had hoped would go to Dean certainly seemed Sunday to be jettisoning the idea of creating a government-organized alternative to private health insurance Sunday. Appearing on CNN's State of the Union program, HHS Secretary Kathleen Sebelius dismissed the public option as "not the essential element" of the administration's health care agenda.

White House spokesman Robert Gibbs said pretty much the same thing when he appeared Sunday on the CBS News program Face the Nation.

"What the president has said is in order to inject choice and competition…people ought to be able to have some competition in that market," said Gibbs.

Pressed on whether the administration was abandoning the public option, Gibbs would only say that, "The president has thus far sided with the notion that that can best be done with a public option."

Startlingly, the clearest signal that the administration is preparing to jettison the public option came from Obama himself. Speaking at a town hall event in Colorado, the President referred to the public plan as merely a "sliver" of his reform agenda and said: "The public option, whether we have it or we don't have it, is not the entirety of healthcare reform."

On this, Obama is right. The public option has already been so dumbed-down and neutered that it is little more than a sliver. The problem is that it may be the only sliver of real reform in his program.

Even with a robust public option, the president's initiative looks a lot like a bailout for the insurance industry -- in stark contrast to the a single-payer reform that would replace industry profiteering with a not-for-profit system like Medicare.

Without a public option, there is no real reform.

Dean argued in Pittsburgh that: "The public option is (incremental reform)... But there is no incrementalism without the public option."

In fact, without the public option, the Obama approach -- and that of compromise-prone Democrats in Congress -- looks increasingly like a step in the wrong direction.

That's because the "reforms" currently under consideration threaten to undermine Medicare and Medicaid -- with radical cost-cutting schemes -- while steering hundreds of billions in federal dollars into the accounts of for-profit insurers and the pharmaceutical industry.

This is not "change we can believe in." This is change that serious reformers will find "very difficult" to support, as Congresswoman Eddie Bernice Johnson, D-Texas, said Sunday on CNN. Johnson explained that progressives would have a tough time backing legislation that did not include a public option.

"The only way we can be sure that very low-income people and persons who work for companies that don't offer insurance have access to it, is through an option that would give the private insurance companies a little competition," explained Johnson, a former chair of the Congressional Black Caucus who once worked as the chief psychiatric nurse at the Veterans Administration Hospital in Dallas.

Congresswoman Johnson is exactly right. Without a robust public option, what the Obama administration and compromised Democrats in the House and Senate are talking about is not "health care reform."

It is "health care deform" that does not begin to address the crisis created by insurance industry profiteering -- and that could well make the "cure" worse than the disease.

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