Here's George Steph on how to properly punch hippies and lose the base:
Here are the five key sets of questions (the Obama staffers) have to confront, both in the Roosevelt Room and in their consultations with Congress:
1. What is "death with dignity" for the public option? Is it better for the president to sacrifice it himself? Or convince Democratic leaders behind closed doors to come to him? Some will argue for taking the public option issue to the floor, passing it through the House and sacrificing it in conference -- but once you've gone that far, it may be impossible for House Democrats to back down. So, giving it up on the front end in some fashion is likely the preferred option.
2. How do you get the price tag down, likely to about $700 billion? At that cost the most unpopular tax increases will not be necessary. And moderates in both the House and Senate have already signaled that they can live with it at that level. Which leads to question 3:
3. Can you still make a convincing case that the country is on a path to universal coverage? What mix of phase-ins and triggers are necessary to make that case?
I can't take it. (If you're interested, 4 asks if any Republican votes other than Olympia Snowe can be gathered - even the White House knows that answer is no - and 5 queries how to do the speech, possibly with a joint session to Congress.)
Stephanopoulos is very plugged in, and so this could very well be the discussion at the White House. Who apparently have yet to figure out that forcing millions of Americans into buying crappy insurance that can only come from private industry will be so massively unpopular that, if Republicans don't repeal it, Democrats will be forced to themselves. That would be the quickest and easiest way possible to squander the majority, which at times I think is the Washington Democratic establishment's metier.
But number two on Steph's list is arguably scarier. And with all of the talk of the public option, this is something that doesn't get discussed as much in liberal circles, though it's quite important.
Practically all of the money spent in this health care bill goes to two things - expanding Medicaid and subsidies for individuals to buy insurance. That's it. And it's incredibly important. You're talking about the vast majority of the 47 million insured, people who cannot afford health insurance, being able to get coverage for the first time. The coverage that would be subsidized by the government would be subject to strict regulations - insurers would have to take all comers, couldn't deny a claim after the fact, would have to offer a similar price to everyone in a community regardless of medical history, and would have to offer a baseline of care. In addition, they would have to use a certain percentage of their premium revenue on actual health care. This would create a workable individual market that would at least move us toward the goal of universal coverage, albeit in a jury-rigged fashion.
Reducing the cost of the bill either keeps more people off Medicaid or reduces the subsidies, making forced insurance under an individual mandate unaffordable. You would have to pull back from subsidies at 400% of the federal poverty level to something like 200%, and probably not expand Medicaid at all (the House bills call for expansion to 133% FPL, the Senate HELP bill ups it to 150%). There's this notion that bloggers and progressive groups don't care about the poor, but we're not writing the bill, and kowtowing to the lunatic moderates who put a price tag above morality except when talking about war. I have understood from the start that the coverage expansion elements of the bill were crucially important, and the same thinking that artificially lowered the stimulus cost to the detriment of state budgets and public investment would doom the coverage expansion elements.
Furthermore, insurance companies have sought to reduce the percentage of premiums they would have to spend on health care, and how much of that cost they would push off to customers (Insurers would have to pick up at least 76% of care in the House bills, but 65% in the Senate Finance draft, according to reports). While the public option remains crucial, these coverage expansion policies and insurance regulation also must be demanded as the minimum requirement for liberal support of the bill.
After all that, after assuring us that the wise course would be to ditch a public insurance option that would only exist to cut costs, and reducing the coverage expansion funds and subsequently putting the burden of universal coverage on the backs of poor people, Stephanopoulos asks, basically, "How can we lie about this to the public?"
I find it hard to believe that the White House would be so stupid as to think that making the least popular choices to the majority of Americans making under $60,000/year would be just the ticket to increase the President's popularity.