Senate health bill has public option, no thanks to Obama

Good news, part 1: Senate Majority Leader Harry Reid announced yesterday that the health care bill he’ll bring up on the Senate floor will have a public health insurance option. That means opponents of the public option will have to try to strip out the measure with amendments on the Senate floor. They don’t have 60 votes to do that.

Good news, part 2: at yesterday’s press conference, Reid “definitively stated that a trigger bill wouldn’t get a [Congressional Budget Office] score – effectively taking it off the table as a legislative option.” The insurance industry and its allies in Congress, including Republican Senator Olympia Snowe, have pushed the “trigger” idea because it would virtually guarantee that the public option would never go into effect.

Bad news, part 1: Reid’s compromise would allow states to opt out of the public health insurance option, and limits participation in the public plan in many other ways too.

Bad news, part 2: At crunch time, President Barack Obama did nothing to help progressives fighting to strengthen the health care bill. On the contrary, he urged Reid to drop the public option in favor of a “trigger.”

More thoughts on that betrayal are after the jump.

Health care reform is the most important part of Obama’s domestic policy agenda, but you’d never know it from the way he has given up on various elements he promised to enact, such as:

   * A new national health exchange open to all Americans

   * A new public plan available to all Americans to compete with private insurance

   * An employer mandate to provide health insurance

   * A minimum medical loss ratio for insurance companies

   * To allow people to import cheaper drugs from Canada or Europe

   * To repeal the ban that prevents the government from directly negotiating with drug companies

Note none of these promise are part of the Senate Finance Committee bill. Obama has made no effort to fight for the inclusion of some of these (public option, employer mandate, minimum medical loss ratio) and months ago even made secret deals vowing to actively work to kill drug re-importation and direct drug price negotiation.

During the election Obama actively campaigned against two policies. One was the individual mandate favored by Hillary Clinton (and the health insurance industry) and the other was a tax on employer-provided health insurance which was also supported by John McCain. These two issues are now part of the Baucus bill. Since taking office, Obama has spent dramatically more time and political capital fighting hard to include these two provisions that he opposed than he has spent trying to include top progressive/labor union priorities that he supported, like the public option.

And in a double whammy, during a series of secret back room deals (breaking his promise for complete and open transparency) he has promised different industries he will actively oppose the very ideas he once claimed to champion, drug re-importation, and direct drug price negotiation.

Amazingly, public pressure on Congressional Democrats has managed to keep the public health insurance option alive despite the predictions of most pundits and many signals from the White House that Obama could live without it.

During the past week, Senate leaders have worked on merging the health care bills passed by the HELP and Finance Committees. Reid spoke with almost everyone in the Democratic caucus. Various vote counts floated around the blogosphere, but everyone agreed that we were very close to 60 senators promising not to filibuster health care reform (even if some planned to vote against the bill in the end). That was the time for Obama to pick up the phone and start twisting arms or cutting deals with the last few Democratic holdouts. But instead, he made sure Reid knew that he wanted Republican Snowe on board, and for that reason preferred a bill with a trigger.

That’s right, the president leaned on people trying to help him keep his own campaign promises, instead of fighting for those last few votes. From the Huffington Post on Saturday:

“The leadership understands that pushing for a public option is a somewhat risky strategy, but we may be within striking distance. A signal from the president could be enough to put us over the top,” said one Senate Democratic leadership aide. Such pleading is exceedingly rare on Capitol Hill and comes only after Senate leaders exhausted every effort to encourage Obama to engage.

“Everybody knows we’re close enough that these guys could be rolled. They just don’t want to do it because it makes the politics harder,” said a senior Democratic source, saying that Obama is worried about the political fate of Blue Dogs and conservative Senate Democrats if the bill isn’t seen as bipartisan. “These last couple folks, they could get them if Obama leaned on them.” […]

It is not philosophical, one White House aide explained, but is a matter of political practicality. If the votes were there to pass a robust public option through the Senate, the president would be leading the charge, the aide said. But after six months of concern that it would be filibustered, the bet among Obama’s aides is that Reid is now simply being too optimistic in his whip count. The trigger proposal, said Democratic aides, has long been associated with White House Chief of Staff Rahm Emanuel.

“He’s been so convinced by his political people from the beginning that we can’t get a bill with a public option, he’s internalized it. Even though it’s now become obvious we can get a bill without selling out the public option, he’s still on that path,” said a top Democratic source. The White House, he said, continues to assure progressives it’ll improve the bill in conference negotiations between the Senate and House, but advocates are unconvinced.

Click here for links to other reports on White House efforts to craft a bill that would appeal to Snowe instead of a bill with a public option. Senator Tom Harkin voiced his frustration to a reporter for The Hill:

After Obama met with Pelosi, Reid and other Democratic leaders Thursday, the White House repeated its message that Obama supports the public option but will not rule out the trigger or any other compromise.

That is not good enough, Harkin said. “I’ve not been very happy with the White House’s lukewarm support of the public option,” he said, articulating a gripe liberals have been making for months.

Lacking the ability to read Obama’s mind, I have no idea whether he truly believes a “bipartisan” bill with Snowe’s support in the Senate and no Republican votes in the House is worth giving up a major campaign promise. My hunch is that Obama wants to keep up his end of the deal the White House struck with the insurance industry earlier this summer, and courting Snowe provides a good cover for doing that. But in the final analysis, it doesn’t matter.

What matters is that the president’s signature domestic policy agenda item is on the line, and the White House can’t be bothered to round up the last few votes.

According to Senator Dick Durbin, progressive senators unwilling to vote for any bill without a public option in effect forced leadership toward the “opt-out” rather than the “trigger.”

Hardened Obamaskeptic that I am, even I’m disappointed that the president actively discouraged Reid from including a public option in this bill. The White House announced yesterday that Obama was “pleased that the Senate has decided to include a public option for health coverage,” but those words ring hollow when everyone knows the president tried to avoid that outcome. Getting health care reform right would seal Obama’s place on the list of great presidents, but he’d rather stay out of the scrum while privately urging leaders to weaken the bill. Pathetic.

I feel sorry for the dedicated Obama supporters who worked hard on his behalf during the primaries. Many of them are as disappointed as icebergslim.

But I feel sorrier for the Americans in states that are likely to opt out of a public health insurance option. While it’s still not clear how Reid’s opt-out provision is structured (and some think no state would opt out), thousands of red state residents are probably being sold down the river because of a few corporate hacks in the Senate Democratic caucus. And the president would have settled for even less.

The floor is yours.

  • A bit Cynical I Think

    I’m not sure how much I trust the HuffPo article.  It sounds a lot like gossip to me.  Everything the White House has said publicly has been supportive of the public option.  I’m inclined to give them the benefit of the doubt until its proven otherwise.   I really don’t think Harry Reid would have included it over the President’s objection either.  Not his M.O.  

    I hope if comes up for a vote regardless of having 60 for sure.  And then I hope they actually MAKE them filibuster.  I’d love to see Lieberman, Nelson et al. derail the top Democratic priority of the last 40 years and stay in the party and their chairmanships going forward.  I don’t think they’d do it.  They aren’t that stupid.  Especially with the opt-out as a cover.

    • many other accounts

      support the HuffPo story, including Ezra Klein and Talking Points Memo.

      Being publicly supportive (while sending out Axelrod, Sebelius and others to say the public option isn’t a deal-breaker for the president) is different from working behind the scenes to get those last few votes. I’ve yet to see any account of the White House using carrots or sticks to win over people like Lieberman, Landrieu, Ben Nelson, etc. They are not really trying to make the bill stronger.

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