Forty one days ago, The New York Times declared that the congressional Democratic push for a government-run health insurance option was “dying,” and the story itself read like an obituary. Yet, as evidenced by the Democrats’ frenetic activity during the past 48 hours, the so-called “public option” is indeed very much alive (as a concept, anyway) and seemingly destined for inclusion in the final reform packages that may soon be grist for floor debate. Perhaps because the failure to do so would devastate the party's liberal base and wreck the party's short-term political prospects.
The only big hitch - not an inconsiderable one - is that the policy specifics of a public option have yet to be determined. Crafting a compromise within the Democrats’ big tent will not be easy; nevertheless, with the 2010 midterm elections looming ever closer, the party’s congressional players have no choice but to strike a policy deal that will not only benefit the largest possible number of uninsured and ill-insured citizens, but also extend political protection to the largest possible number of congressional Democrats.
In order for the Democrats to minimize their likely losses in the ’10 midterms (the party in power has lost seats in virtually every midterm during the past century), they have to ensure that their liberal base is sufficiently motivated to vote, and that independents in swing House districts are at least persuadable. Obviously, those two constituencies will be greatly influenced next year by the state of the economy, and the status of the war in Afghanistan. But the fate and specifics of health care reform are also likely to be major determinants of voting (or non-voting) behavior.
The Democrats’ late-week maneuverings on the public option can be viewed through this political prism. Clearly, Harry Reid and Nancy Pelosi are ever so slowly groping toward a legislative compromise that – if successful – would motivate liberal voters to show up at the polls 13 months from now (because, ideally, they’ll feel that the enacted public option is sufficiently substantive), while convincing swing independents that the public option is sufficiently modest and therefore no threat to the free enterprise system.
This is a difficult political challenge, roughly akin to the old saw about fitting a square peg into a round hole, but such is the nature of compromise. Which is why we’ve heard so much more during the past 48 hours about a proposed public option that would permit some states to opt out (which I suppose we can call the “public option option”); about a proposed “trigger,” by which the government health plan would be unleashed in certain states only if the insurance companies misbehave by refusing to provide affordable coverage; about a proposed health insurance pool that would be launched with federal seed money but basically run by a private, independent board. And, of course, there’s the longstanding liberal demand for a Medicare-style public option, shorn of all caveats.
As one Democratic House player said yesterday, “We’re trying to find out which one of these approaches will best suit the most people” – or, more precisely, help get most Democrats re-elected. Because if the Democrats come up empty on a public option, or fail to enact any kind of reform, most liberals will be too fed up to vote in ’10 – thus ceding the voting booth to the angry and motivated Republican right. And even if a public option is enacted, many liberals will be disenchanted if it's not strong enough to compete with the insurance companies. House Democrats who hail from safe, deep-blue districts would keep their seats even if many liberals stay home, but some colleagues from competitive districts would surely be vulnerable to a voting surge from angry conservatives.
That’s one big reason why the Democrats lost the House in the 1994 midterms, in the wake of Bill Clinton’s health reform pitch, and today’s minority Republicans are rooting from the sidelines for a similar reform failure this year. (Granted, such failure would ensure continued misery for the roughly 40 million uninsured Americans, as well as for those who get dumped by their insurance companies after they get sick...but, in the GOP’s political calculations, such unfortunates are merely collateral damage.)
At the same time, congressional Democrats have to ensure that the public option provision is not too ambitious – because that could imperil the lawmakers who will be running for re-election in normally Republican districts. The Democrats have a huge House majority precisely because they picked up a lot of seats in GOP enclaves in 2006 and 2008. They don’t want to cough up those seats in 2010, but they’ll surely lose at least a few if those incumbents are forced to defend a public option that seems too liberal for their districts. And, potentially, we’re talking about a lot of districts; as nonpartisan numbers-cruncher Charlie Cook has pointed out, 48 House Democrats currently represent constituencies that supported both John McCain in the ’08 presidential race and George W. Bush four years earlier.
This is why the Democrats continue to creep along with all deliberate speed, in search of what one House leader calls “our Kumbaya moment.” The upside for Democrats is that the reform effort has already gone farther than ever before, and that all factions are still talking to each other. And hey, a deal shouldn’t be too difficult. To provide the maximum political cover for 2010, all they need to do is craft a rejiggered triggered co-op nonprofit opt-in opt-out public option option.
Or something like that.