I wrote earlier today about my general feeling that the public option, while very important, is not a dealbreaker for me. I see it as a second Very Important Thing, but one which ultimately is less essential than eliminating some of the worst abuses of the current system.
Paul Krugman has a piece today which pretty sharply disagrees with that perspective. I can’t say I disagree with what he has to say, but each of his points invites a lot more speculation than it does resolution.
He has three arguments. First, the public option will bring down costs. I’ve seen people who I trust a lot come down on opposite sides of this question. My general feeling is that it’s probably AN important cost-control measure but I’m not convinced that it’s the only meaningful way to get it done.
But, to be honest, cost-control is simply not that big a motivator for me. Two reasons. One: I think health care is a moral imperative. I simply find it unacceptable to live in a society who can’t establish a general framework for securing basic needs. If it costs a lot, so what? It’s a lot more important than a lot of other things we spend money on. Two – and I’m going to say this as bluntly as possible – if establishing broad coverage raises costs then long-term result is going to be public demand for the government to find more funding. I realize this is basically the Republican fear, but on this issue I think their calculation actually does make sense. When you create entitlements and then those entitlements face cuts people don’t want to give them up. All of the status quo bias which is driving antagonism to health care reform right now will be flipped five years down the road. People will have started to experience the benefits of the program and won’t want to lose it. That’s, in rough terms, kind of what’s happening in Massachusetts right now, actually.
Krugman’s second point is that the public option is the only real competition that can intrude into a lot of markets. Fair enough. I think this is something the trigger is most likely to resolve. The threat in this instance may actually be more useful than actually creating the public option to start with.
It’s his third point that I’m left feeling the least certain about. It’s about the politics of it. There’s the weak version of this argument (which I called creeping Naderism before), namely: liberals keep giving up. We need to fight for the public option simply because we shouldn’t back down. That does not persuade me. The blue team is never going to win a battle of stubborness. We’ll win because people want a side who thinks, considers, and doesn’t behave like spoiled children.
But Krugman brings up this point (which I read somewhere else yesterday but have now lost track of…maybe Josh Marshall?): “Imagine that reform passes, but that premiums shoot up (or even keep rising at the rates of the past decade.) Then you could all too easily have many people blaming Obama et al for forcing them into this increasingly unaffordable system.”
That may be completely true. But I can see the opposite happening as well. We pass a bill that makes things better for a lot of people. None of the stupid stuff (death panels, whatever other lunacies people have been freaking out about) comes to pass. The overwhelming majority of people see it as a successful project. The Democrats get a win and a bump in the polls. And the people who do get screwed over by a mandate which isn’t sufficiently subsidized are (to be blunt once again) not a very large constituency.
In that world, it seems possible that there will be a lot of goodwill about health insurance reform – and some continuing insistence on the need to keep fixing gaps and holes. Making that explicit from the get-go with a trigger is a good idea, but even without the trigger I think even the occasionally inept messaging department of the Democrats could find a way to build a campaign around the following idea:
We promised health care and we delivered. Things are way better for almost everyone. And look at the Republicans – who voted against this unanimously (excepting O. Snowe I guess). What’s more, the ONLY problem with the bill is the fact that it still leaves some people uncovered, or forces some people to be covered without helping them pay. Why did that happen? Because the Republicans only cared about whittling it down rather than caring about actually helping people.
I’m still torn on this, like I said. Obviously my ideal world is a strong public option from day one. But I’m also trying to be realistic and figure out how else they might be able to thread the needle, help a lot of people, and not shoot us in the foot.