It is not the be-all and end-all of health-care reform. It is not the long-awaited safety net for the uninsured. And if, as many liberals hope, it turns out to be nothing more than Medicare for All, it won't do anything to hold down long-term growth in health spending.
There are some days when it almost seems like the national press is making a conscious effort to prove Noam Chomsky’s Manufacturing Consent gospel. If the national commercial media really did exist solely to perpetuate the attitudes of the political elite, and to create phony debates around unthreatening policy poles, endlessly pitting a conservative/reactionary status quo against an "acceptable" position of dissent -- if that thesis were the absolute truth, then you'd see just what we're seeing now in the coverage of the health care debate.
All across the country the news media reacted to the White House leak about the possibility of the public option being dropped with, well, an oddly circumspect tone. Although some initial stories carried a sensational tone, within a day or two the debate had settled down, and the country’s most prominent pundits were considering this treacherous and cowardly development in a pragmatic light. In Eric Etheridge’s review-of-reviewers blog int he Times, the "Opinionator," the situation was described this way:
The debate is primarily on the left, or among the Democrats, where partisans are furiously arguing along two intersecting fronts: First, the public option is or is not an essential element of reform. Second, abandoning the public option will or will not make passing the remainder of reform more likely.
This superficially is true, I guess. There were a few voices arguing that the public option is the bare minimum "reform" that the public should tolerate, and a few who argued that if it is not in the final version, progressives should reject the proposal.
But overwhelmingly the pundits went the route predicted by Manufacturing Consent. The most prominent voices in the last two days have mostly chosen one of two sides to argue. Many attacked the public uproar over the White House’s apparent surrender, blasting the public option as an unrealistic and meaningless affectation, a policy kewpie doll for unrealistic liberals who "don't want to be bothered with the real-life dynamics of the health care market," as the Washington Post's Steven Pearlstein put it (in his column with the amusingly obnoxious title, "Enough Already With the Public Option!"). The White House itself is covertly putting itself in this camp via “unnamed” sources who are expressing rank insider astonishment over the rabble’s naivete, for instance here in the Washington Post:
"I don't understand why the left of the left has decided that this is their Waterloo," said a senior White House adviser, who spoke on the condition of anonymity. "We've gotten to this point where health care on the left is determined by the breadth of the public option. I don't understand how that has become the measure of whether what we achieve is health-care reform."
"It’s a mystifying thing," he added. "We're forgetting why we are in this."
Where the chief executive of any administration is on almost any issue, one can also usually find Hobbit understudy and professional White House apologist Joe Klein. Here he is on health care, licking as usual the presidential jellyring:
Meanwhile, I never had much interest in a public option. I think the perils of government-delivered (as opposed to funded) services are obvious and immense. Sarah Lyall had an excellent piece in the Times today about her dealings with the British National Health System, which has some very real strengths, but also some terrifying weaknesses…. I spent the weekend traveling through the west with the President, watching him perform at health care forums in Montana and Colorado. He did quite well, I thought.
So that's that camp. Then, on the other side, there was a whole rash of others who took the pragmatic, chin-scratching route, embracing in advance the possibilities of a public-option-less health care reform. A lot of the people making this argument seemed to have good intentions. One example was Matthew Yglesias:
A set of consumer protections that would cap out-of-pocket health costs, guarantee access to preventive care, and prevent insurers from treating people well as long as they're healthy only to start monkeying around when they get sick. This would be a big deal. The bills in Congress also envision expanding the Medicaid program that currently serves the poor. This would only help a relatively narrow slice of the near-poor, but for those who are helped, the help would be enormous.
And Kevin Drum at Mother Jones:
So as much as I'd like to have a public option (primarily for its ability to force more robust price competition), I just don't see it as something to threaten nuclear destruction over. If insurance reforms are robust and low-income subsidies are decent, that's a huge win for millions of people, and it's a win we can build on. And contra Atrios, social legislation does have a history of getting better after it's first passed. Just ask Henry Waxman.
Then there was Nate Silver:
The fundamental accomplishments of a public option-less bill would be to (1) ensure that no American could be denied coverage because of a pre-existing condition or because they became sick; (2) subsidize health insurance coverage for millions of poor and middle-class Americans.
These are major, major accomplishments. Arguably, they are accomplished at too great a cost. But let’s look at it like this. The CBO estimates that the public option would save about $150 billion over the next ten years -- that’s roughly $1,100 for every taxpayer. I'm certainly not thrilled to have to pay an additional $1,100 in taxes because some Blue Dog Democrats want to placate their friends in the insurance industry. But I think the good in this health care bill -- the move toward universal-ish coverage, the cost-control provisions -- is worth a heck of a lot more than $1,100.
So this is where the "debate" is being framed. One side argues that the public option isn’t anything to write home about. The other "side" argues that a bill without the public option won’t be a disaster after all. Of course if you're paying attention these are both actually the same argument, arguing the same side.