Back and Forth on Public Option

Ezra Klein and Steven Perlstein of the Washington Post argue for and against fighting for a public option in the health care debate. I agree with Perlstein that the public option is not "the be-all and end-all" of health care reform and that it isn't clear that a public option would necessarily contain costs. However, I do think it would probably be a better start toward cost containment and keeping big insurance honest than any of the alternatives. I think Klein comes closer to getting both the policy and the politics right.

If the public option needs to be dropped to secure passage of the final bill, then that may be the unfortunate reality of the situation. But that's the context in which you drop something like the public option: A context in which you get something significant for the concession, like passage of everything else, or much more money in subsidies and much stronger exchanges. You don't drop it in the hopes that the compromise will be seen by opponents as reasonableness rather than weakness. The public option is good policy and, if it comes down to it, the largest bargaining chip. You don't give it away lightly. But you do have to keep it in perspective.

Jonathan Alter makes a similar point about getting a bill passed as a start on incremental reform in Newsweek.

History suggests that major social policy unfolds on a continuum. The Social Security Act of 1935 disappointed liberal New Dealers because what was called "old-age insurance" covered only about half the adult population. It excluded farmhands, domestics, employees of small businesses, and most blacks. That was because FDR needed the votes of Southern Democrats, the Blue Dogs of their day. (The bill cleared the House Ways and Means Committee with only one Republican vote.) Similarly, the Civil Rights Act of 1957, immortalized in Robert Caro's Master of the Senate, was weak tea. It had to be strengthened by the Civil Rights Act of 1964 and the Voting Rights Act of 1965. In the later bills, Lyndon Johnson betrayed Southerners he had made deals with in 1957.

The core principle behind health-care reform is—or should be—a combination of Social Security insurance and civil rights. Passage would end the shameful era in our nation's history when we discriminated against people for no other reason than that they were sick. A decade from now, we will look back in wonder that we once lived in a country where half of all personal bankruptcies were caused by illness, where Americans lacked the basic security of knowing that if they lost their jobs they wouldn't have to sell the house to pay for the medical treatments to keep them alive. We'll look back in wonder—that is, if we pass the bill.

Matt Yglesias of Think Progress seems to agree.

--Ballard Burgher