Will healthcare reform include a public health insurance plan to compete with private health insurance? President Obama campaigned on the promise of a public option, but over the past week he and his top advisers have repeatedly signaled that they aren’t willing to fight for it.

On Saturday, Obama told a town hall meeting in Colorado: “Whether we have it or we don’t have it, [the public option] is not the entirety of health care reform. This is just one sliver of it, one aspect of it.”

“I don’t understand why the left of the left has decided that this is their Waterloo,” an unnamed senior White House official gripes in this morning’s Washington Post.

The White House is sorely mistaken if it thinks that the public option belongs in the “nice but not necessary” category. Josh Holland of AlterNet explains why the public option is the pillar of healthcare reform. Without it, there’s little hope of containing costs or reigning in the power of insurance companies:

 

“It may be just one “aspect” of health reform, but without it, the legislation promises to be a massive rip-off; a taxpayer give-away of hundreds of billions of dollars to an unreformed ‘disease care’ industry.

The industry would get millions of new customers thanks to generous government subsidies and a law requiring that (almost) everyone carry insurance. And that windfall would come without the structural changes needed to bend the medical “cost curve” in years to come — without any provisions that might endanger the industry’s bottom line.”

 

In Salon, Robert Reich agrees. Competition between private insurance companies and the public option is the only hope to controlling costs. A public plan could bargain with providers to reduce costs and pass the savings on to taxpayers. The private insurance industry would have to slash its prices to compete.

Without a public option, “reform” would likely involve subsidies to private insurance companies, temporarily dulling the pain as premiums rise unchecked. That’s the worst of both worlds.

Progressives shouldn’t be surprised at the White House’s noncommittal stance, though. Obama campaigned on a public option, but he has always framed it a darned good idea, not as a non-negotiable demand.

Why is it so difficult to get a healthcare bill through the Senate with the supposedly filibuster-proof majority? The simple answer is that the Dems need 100% of their delegation to cooperate in order to break a filibuster. So, the Democrats have 60 seats in the Senate but no way to advance their agenda without capitulating to the conservative Blue Dogs. The Republicans can be counted on to filibuster whatever the Democrats come up with. Which means that conservative Democrats like Sen. Max Baucus (D-Mont.) hold the balance of power.

As Ari Melber of The Nation explains, Baucus and his Republican counterpart Sen. Chuck Grassley (R-Iowa) also rule over the powerful and conservative Senate Finance Committee, which has been tasked with writing the Senate version of the healthcare bill.

Also in The Nation, Tom Geoghegan argues that it’s time to break the stranglehold by abolishing the procedural filibuster. Unlimited debate in the Senate is enshrined in the constitution. In an old school filibuster, senators simply refuse to shut up until the session ends and the bill dies without a vote. In 1975, a group of liberals wrote a rule of Senate procedure that effectively allows senators to “filibuster” simply by saying they want to. In the old days, a filibuster was a grueling public ordeal. Senators slept on cots and spelled each other off. Today, “filibustering” means signing a form. It’s private, easy and cost-free. The Republicans can, and will, filibuster all major Democratic legislation without having to stand in public and risk being branded as obstructionists.

As a result, 60 is the new 50 in the Senate. Since it’s just a rule, the procedural filibuster could be abolished by a simple majority vote. Friends of the filibuster defend it as a bulwark against tyranny. Abolishing the procedural filibuster would discourage frivolous obstructionism, but keep the old school filibuster for cases when legislators actually care enough to lose sleep over it.

Ever wonder why the strongest public option, single-payer, was never on the table? Maybe because even the strongest proponents of the public plan are taking money from the insurance and biomedical industries. Mother Jones Rachel Morris wants to know why UNITEDHealth consultant Tom Daschle was on Meet the Press Sunday. A former Democratic senator, Daschle is a senior adviser to Obama on healthcare reform and a leading advocate of a public plan. However, he recently resumed a private consulting arrangement with UNITEDHealth, America’s largest health insurer.  Even public plan champion Howard Dean is a strategic adviser on healthcare policy to the lobby firm of McKenna, Long, and Aldridge. Dean won’t disclose his clients, but McKenna represents a number of clients in the biomedical and health science industries.

The prospects of a public option are dimming, but not necessarily because of any rapid about-face by the White House. The Senate bill is in the hands of the Blue Dogs, who say they won’t have legislation until November. Obama won’t put the screws to the Blue Dogs, but there’s still plenty of time to for citizens to make their voices heard.

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