As a deadline for introducing a health care reform bill approaches the progressive community, which has been biting its tongue for weeks if not months, is now making calculated moves to force President Obama's hand.
Several times on the campaign trail candidate Obama called for sustained pressure from the left to enable him to make more ambitious policy decisions in the health care arena. Former DNC Chair Howard Dean echoed these sentiments at a recent panel on the future of health care reform and urged the American people to "hold their [Democratic representatives'] feet to the fire to make sure they behave like Democrats."
In anticipation of a heated ideological debate, the White House is now shifting the parameters of the discussion -- from the philosophical to pragmatic. A report released by the Council of Economic Advisers (CEA) on June 2, stressed the economic necessity of passing healthcare reform as a means of lowering the deficit while increasing gross domestic product.
The study weighed projected costs under the current system against a set of anticipated outcomes if healthcare reform is passed.
One such outcome is the slowing of the annual growth rate of health care costs by 1.5 percent. Accomplishing this, said Christina Romer, chair of the CEA, would generate a 2 percent increase in GDP in 2020 -- compared with a "no-reform baseline" -- and an increase of almost 8 percent by 2030. For the average family of four, these cost reductions would translate to an additional $2,600 in income in 2020 and an extra $10,000 in 2030. It's the equivalent of a "billion dollar bills lying on the sidewalk," said Romer of the existing system.
By framing the debate in terms of economic imperatives the administration seems to be seeking to ward off partisan politics for as long as possible. "You don't see anyone walking out yet,' said David Cutler, Professor of Applied Economics at Harvard University and veteran of the Clinton era healthcare battle.
Maybe so. But progressives are drawing increasingly bold lines in the sand:
"We have polled [Congressional Progressive Caucus] members very carefully in recent weeks and a strong majority will only support comprehensive healthcare reform legislation that includes a public plan option on a level playing field with private health insurance plans," CPC co-chairpersons Lynn Woolsey (D-CA) and Raul Grijalva (D-AZ) wrote in a letter to the Speaker of the House and Senate Majority Leaders in early April.
Speaking to the America's Future NOW! conference, Dean said, "We cannot spend a trillion and half dollars of the taxpayer's money by rearranging the chairs on the deck of the Titanic!" If there's no public option, do nothing! Don't waste our money."
Simply including the words "public option" may not be enough. One alleged compromise put forth by Republicans and some centrist Democrats to scuttle a public plan option, is the notion of a trigger that would mandate its implementation only if the private market fails to meet a certain set of criteria. This model would resemble the Medicare Part D option, which conservatives tout as evidence that there is no need for a public option because the trigger for Medicare Part D has yet to be pulled. However, upon closer inspection, the patients themselves have no control over the criteria that would lead to pulling the trigger if their needs are not met, ensuring that the option of a public plan was never really a viable one, say some health care experts.
"The trigger [under Medicare Part D] would come into play in any county where there weren't at least two private drug plans, but that has never come close to happening. It has nothing to do with containing costs or guaranteeing quality or access or anything that works for patients and consumers," said Jacki Schechner of Healthcare for America NOW.
But even if progressives hold the line and insist on a public option worthy of its name, the question remains, what would such a plan actually look like? Romer, in her final words to a room full of reporters and members of the medical community called on health care practitioners and physicians themselves to pitch in with ideas. "The people who actually know what the reforms [should be] need to stand up," she said.
She might just have an answer. One of those physicians, Dr. Salomeh Keyhani of Mount Sinai hospital in New York, who was speaking on the same panel as Dean, said that the "silent majority" of physicians who support a public plan are poised to do just that.