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While the debate continues over whether our support should or should not be given to HCR in its current guise, I can't ignore the path or paths not taken. The consequences of the choices that Obama made on the road to getting us where we are today are simply too important to gloss over. The rejected options that I list below for the most part were not stand alone and mutually exclusive choices. Many of them could have been coupled in different combinations to increase their individual potency. I start with Obama's campaign platform that called for offering Americans a widely available and robust public option as an alternative to individuals purchasing private for profit health care insurance, and explore how that promise could have been made good. I recognize that in some instances an argument can be made that at some point Obama tried to go down one or the other of the paths I list below. In those rare instances I argue that it was a case of an effort either too little and/or too late for those efforts to sufficiently matter.
We can and probably will argue about the likelihood that each of the means to fight for a Public Option that I outline below could have made a critical difference, or even if they all would have been desirable to pursue. But it isn’t a short list, and the cumulative effect of all of them being virtually if not completely ignored as a strategy to win a robust public option as part of Health Care Reform, I believe calls into question whether that was ever really a serious Obama Administration goal. In no particular order here they are:
1) The Truncated Choices: Single Payer was never on the table even as a chip to be retired during negotiations. Obama could have framed the Health Care Debate as an honest exploration of the full spectrum of choices facing the U.S. going forward. Single Payer has a significant chorus of backers, many sitting in Congress, so it could not be dismissed as a concept only advanced by the fringe, especially since other major western industrialized nations embraced Single Payer as their solution to the health care problems America faces today. A robust debate that detailed many of the advantages that Single Payer offers might have been something some Centrist Senators would have been willing to cut a stronger Public Option deal in order to avoid. We will never really know because Single Payer is a chip that never hit the negotiating table.
2) Refusal to invoke Medicare as a positive example of a government run program: Alarm bells were ringing for me when a Democratic President chose NOT to emphasize praise for the positive difference government run Medicare has made helping the lives of senior citizens who as a group have the most challenging health care issues of any large segment of our society. Even older Tea Party protesters by and large are loyal to their Medicare coverage. The Public Option could have been linked literally or figuratively to a popular Medicare program but it wasn’t. Republicans were given a largely free hand defining a government run health insurance as a Socialist takeover that would pull the plug on Granny. The reservoir of positive feelings most Americans have for Medicare was seldom if ever tapped into to build support for the Public Option.
3) No line drawn in the sand for a Public Option: Neither in public, nor if a number of Democrats in Congress are to believed, in private either did Obama emphatically demand that a Public Option be included in any Health Care Reform package that passed through Congress. Had Obama, riding high in public approval ratings, invested more of the prestige of his Presidency on insisting on a strong Public Option as part of any final deal, the hand of supporters of that Public Option in Congress would have been strengthened greatly. I am not even describing an explicit veto threat, quarries on that specific point could have been answered with diplomatic ambiguity as in “I don’t expect we will reach that point but it certainly is an option open to me that I would very seriously have to consider”.
4) The Bi-Partisan Fetish: Who doesn’t love one big happy family, but if it’s clear that it’s not going to happen someone has to get the blame while you concentrate on taking care of the people’s business even without that broad consensus. Rather than harshly calling out the National Republican Party for a clear and obviously premeditated obstructionist stance that 90% of the sentient beings in the Universe had already seen clear through, Obama insisted on singing the praises for obtaining bi-partisan agreement on reforming our Health Care system well into late Fall. Let’s give him one and say that Olympia Snowe actually negotiated with Democrats in good faith; close call but let’s just say that’s true. One Republican in Congress does not a bi-partisan approach make. The charade of an unaccountable to the public, let alone other Senators, cabal pulled together by Max Baucus behind closed doors to negotiate a bi-partisan approach to Health Care Reform added many long weeks if not months to the legislative timetable reform efforts followed. During that time the Obama Administration largely held its fire on Republicans so as not to upset “delicate negotiations” while the Republican Party used every gun in it’s arsenal to train sustained heavy fire on all of Obama’s efforts. The quest for elusive Republican support contributed further to compromises, and kept the Obama Administration on the defensive instead of on offense.
5) Failure to evoke the then fresh Corporate driven near complete economic melt down: If there was ever a time in recent American history when “Privatization” should have been a four letter word it was when Barack Obama took office and the 8 months that immediately followed. If there ever was a private sector of the economy viewed less favorably than the fat cat Wall Street bankers who thoroughly gamed our economy, it is private health insurance providers who thoroughly gamed our lives, the clever immoral inventors of the “pre-existing condition” concept who keep experiencing record profits while increasing numbers of Americans die through their malign neglect. Under that dramatic set of circumstances, a government mandated expansion of the reach such a discredited private sector industry has into all of our lives, an industry that millions of Americans can personally recite vivid horror stories about, should not even have been on the table without an at least equally large expansion of the public sector also. Yet Republicans and some blue dog Democrats were repeatedly able to cite their concern for protecting the health of that industry’s profits as an argument against creating a robust public option, without facing strong counter arguments from the White House, at least not until late in the game..
6) Refusal to threaten a turning of the screws against early non Republican resisters: Dramatic major national policy initiatives are seldom if ever moved through Congress without at least the credible threat of some serious Presidential arm twisting and/or future repercussions to erstwhile allies for failing to fall into line. It’s hard to detect even a whiff of that pressure having been applied to opponents/skeptics of the Public Option, and there is no one who denies the truth of that observation. When the White House has put pressure on Democrats to fall in line, it has been for the compromises that at first badly weakened and then finally eliminated the Public Option.
7) Failure to exhort his base to pressure Congress to deliver a robust Public Option: First on display during the 2008 Democratic primaries and later during the Presidential race, there has never been a national Democratic Party leader more skilled at attracting and harnessing the energies of a vast grassroots base of followers than Barack Obama. Early in his administration Obama went to great pains to institutionalize mechanisms for retaining that direct connection with his grassroots base of supporters, which is exactly what he promised to do during his Presidential campaign, as a way to over ride institutional inertia and deliver on his campaign pledges to America. At no point did Obama issue a call to that carefully assembled and maintained base of supporters to specifically lobby Congress for the preservation of a robust Public Option in his overall Health Care Reform proposals.
8) Refusal to openly brandish the Senate Reconciliation Process as a back up option: Reconciliation has always been an arrow available in the Democrat’s Senate quiver for dealing with a minority of determined willful obstructionists to real health care reform. The use of it has the potential to instantly transform someone like Joe Lieberman from a king pin into a has been. While it is not applicable to many matters of regulatory reform, it could be used to pursue the significant budgetary savings that an expansion of Medicare and/or the creation of a robust Public Option can be claimed to offer. And since it only takes 50 Senators plus Vice President Biden to get a bill through the Senate with reconciliation, using this route could bypass the need to even consider most of the watered down compromises of a robust Public Option that were made while looking for votes on the way to the Senate killing it off completely in their final legislation. While reconciliation was never completely ruled out by Democratic leadership, it never was openly used as leverage against obstructionists blocking progress in the Senate either. Even a plausible serious threat to enact a very robust Public Option via reconciliation might have convinced one or two Republicans, centrist Democrats, and/or Lieberman to at least allow for cloture on debate of a conventional Senate bill with a less robust Public Option contained in that instead. And the threat of reconciliation need not have been only an idle one.
9) Decision not to threaten the end of the Filibuster; the so-called Nuclear Option: Republicans went to great efforts to educate the public of this option back when they still controlled the White House. The filibuster as a Senate option can be wiped away at any time by a bare majority of Senators willing to be party to killing it for all time. Without a filibuster to contend with, Health Care Reform or any other issue on the Democrat’s agenda can pass through the Senate with a simple majority vote and there would be little or nothing Republicans could now do to prevent it with their current depleted numbers in that chamber. It would dramatically change the way the Senate has conducted business in recent years, some say for the better, some say for the worse, but without the threat of a filibuster Obama could easily have passed virtually any Health Care Reform that he wanted through the U.S. Senate. The thing about the nuclear option though is that it is so sweeping in its long term consequences that simply threatening to trigger it off can be a potent negotiating tool in itself. Republicans were generally pleased with the result such a threat had on Democrats behavior in the Senate after the Republican leadership seemed poised to go that route. Obviously triggering the nuclear option would have swept away resistance in the Senate to a real public option and an expanded Medicare buy in, but just the threat to do so might have worked a minor miracle. A few Senate Republicans with little to fear from a conservative backlash against them (and there are at least 3 at least somewhat moderate Republican Senators who fit that bill) could have joined most Democrats in voting for cloture on Health Care Reform in return for a promise to bury the nuclear option again.
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