Nominally at least that means that health reform is now in a legislative dead zone—there aren’t the votes in the House for a bill without a public option and there aren’t the votes in the Senate for a bill with them. If it comes right down to it and the senate is prepared to pass a bill that:
(a) subjects insurance companies to tough new restrictions,
(b) taxes employers who don’t provide decent health insurance to their employees,
(c) creates a new regulated marketplace in which individuals and small business employees can buy quality health insurance,
(d) expands Medicaid eligibility, and
(e) offers subsidies to ensure the affordability of insurance for middle class families
I have a hard time believing that House liberals will really kill the bill. But maybe they will.
It is certainly possible that a bill without a public option but with these kind of elements could emerge that would be enough of an improvement over the status quo that House progressives probably would and probably should vote for it. But:
- A lot of the devil is in the details, especially with respect to (a) and (e). A bill with an individual mandate but that doesn’t require companies to supply good insurance and without sufficiently generous subsidies could well make things worse for many middle class working people despite the expense of the program. And the same insurance company lickspittles who are determined to remove the public option are likely to do everything they can to water down the regulatory restrictions on insurance companies too.
- Consequently, it’s crucial that House progressives maintain the pubic option as a line in the sand, if only for bargaining leverage.
- I’m not sure what to think about the possibility of adding a public option later on. I wouldn’t say it’s impossible, but I also certainly wouldn’t count on it. If a bill would only be acceptable on balance if a public option was added fairly quickly, I would say it should be rejected.