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The Public Option? It's About Accountability

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It's fashionable in media circles right now to treat the "public option" as nothing more than the political football du jour, to discuss it only in the context of vote counts and political strategizing, to write it off as a particularly hysterical obsession of the political "left", and -- oh, yes -- to declare it dead.

But the fate of the public option is not yet sealed. And it's much more than just a bargaining chip. The concept of offering health care consumers a government-run alternative to the rogues that comprise the modern American insurance industry not only has a powerful appeal to the general populace, it's central to effective health care reform, both symbolically and concretely.

In fact, the most extraordinary thing about the mainstream media's attitude toward the public option is how an opposition movement so obviously born of the insurance industry's rapacious self-interest, so blatantly fueled by calls to arms that have little to no basis on reality, and so dependent on a particularly ugly strain of know-nothingism, has become viewed by our elite journalists as the pinnacle of rational centrism.

Let's be blunt. The public option -- emphasis on the word "option" -- is a way to hold the insurance companies accountable should they (entirely unexpectedly, of course) fail to live up to their promises, ignore the rules, and keep doing things the way they have for the past several decades.

By contrast, the core of the argument against the public option is nothing more than a sort of whiny plaint of "Leave the insurance companies alone!"

But it's a well-funded plaint. The public option is a grave threat to the regime of obscene profit-making that has left the health care industry with plenty of cash to now throw in reform's way.

The growing "opposition" to the public plan is a direct result of that money. This is -- remember -- exactly how money works in Washington. It buys congressmen. It buys message. It generates publicity. It even makes presidents flinch. For the political journalists to whom this is all just a big game, those are the things that matter the most: Who's up and who's down, who's winning the message wars, the soundbite battles and the day's "visuals."

But the public option deserves better journalism than that. It deserves to be covered for what it means. And in this case, what a public option that provides an alternative to consumers means is that there would actually be consequences in the coming years if things don't turn out the way our good-hearted leaders intend.

Without consequences -- as we've seen in the runaway national security establishment of the Bush era or the colossally irresponsible behavior of financial titans that drove our economy to the brink of disaster -- things go out of control. Anything goes -- regardless of the "rules."

Are you really confident, for instance, that the insurance industry will work hard to control health care costs? Our health insurance chieftains have been talking about that for decades. But rather than do it, they seem perfectly happy taking a big cut of an ever-bigger pie -- and focusing their cost-cutting energies on denying coverage to people when they need it. This seems to work for them. Changing the rules under which they operate may have some modest impact on their behavior, but not nearly as much as will looking over their shoulders and seeing a government-run program bending the cost curve, lowering rates, and improving service.

The presence of an alternative -- a choice -- is critical. It's also about as American as apple pie. The insurance companies themselves understand this very well. The industry-backed PR firms that are bankrolling and inciting ostensibly "grassroots" protests understand this. That's why they encourage talking points about a "government takeover" of health care, rather than anything based in reality. They know full well that a public insurance option -- that, initially, relatively few people could even avail themselves of -- doesn't lead to doctors working for the government or committee of bureaucrats deciding who lives and dies.

That's also the reason why critics were absolutely right to cry foul when the word "choice" was removed from a recent poll's question about the public option -- and support predictably "dropped" like a rock. (See Sam Stein's latest on that story.)

The single biggest mystery about the public option remains: Why is the White House so peripatetic in its support for the measure? Who is whispering in President Obama's ear that compromise is the way to go here, when nobody else is compromising; that bipartisanship is still the goal, when the Republicans are clearly gearing up to use health care as a wedge issue; that health care co-ops, which no one can even define, are a legitimate alternative?

The high priests of Washington conventional wisdom summed things up this morning in a Washington Post editorial calling for the public plan to die. "This is not a matter of ideology but of political nose-counting," said the editorial. "[T]here's no way to amass 60 votes with a public option in the bill."

Now as it happens, that last part, as Ryan Grim wrote recently, ain't necessarily so. With a little gumption, Obama and Democratic leaders could present the caviling Democrats with an up or down vote on a bill that includes a public option -- and dare them to torpedo the whole package.

But regardless: The goal isn't just to get something passed. That's how you end up with no-reform boondoggles like "No Child Left Behind."

Real reform doesn't emerge from government by (faulty) nose-counting. It requires respect for the facts, a serious approach to the issues -- and a little common sense. Oh wait, that's just crazy leftist talk.

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