There were two, fresh neon warning signs that President Obama will pay lip service to a public option in the health reform plan and then scrap it later. The first warning sign was his kind of, sort of tout of a public option in his address at the AFL Labor Day picnic in Cincinnati. Obama left more than a few listeners scratching their heads when he said he backed a public option and then muddled things by saying that he considered it part of a basket of insurance choices.
The second searing warning sign is the probably deliberate leak from Senate Finance Committee Chairman Max Baucus's office that the public option is nowhere to be found in his plan. Worse, it has not been a key part of the round-the-clock negotiations among the key players, starting with Baucus, on the finance committee.
The Senate Finance Committee is the name of the congressional game on health reform. Without Baucus and the handful of other swing senators that Obama desperately banks on to seal the deal on some plan, health care reform is effectively dead. If so, Obama's political capital and personal prestige would nose dive even further. He has no choice but to kiss Baucus and the committee member's rings. Unfortunately, the public option is not on their fingers.
The mixed signal from Obama and the flat rejection by Baucus of a fully functioning and fully funded public option is no surprise. It was simply the latest in the long line of neon bright warnings that the public option will go when it's crunch time.
Health and Human Services Secretary Kathleen Sebelius got rapped on the knuckles a few weeks back when, in an unguarded moment, she forgot the administration's line on the public option and said that it could be excised from Obama's plan if that's what it took to get Senate opponents to back the reform bill. Sebelius back-pedaled fast and publicly vowed that the public option was very much in play and implied that Obama would fight hard for it. It made good copy, and for the moment lessened the howls from labor, liberal Democrats, and progressives that Obama had completely caved to the GOP and Blue Dog Democratic senators. But Sebelius didn't say anything that White House Chief of Staff Rahm Emanuel hadn't hinted at earlier -- and that was that the public option was expendable if that's what it took to get a deal.
Even if Sebelius, Emanuel, and Obama hadn't dropped the hint that the public option can be tossed, it would likely go. This has much less to do with angry town hall loudmouths; the drumbeat of Fox News, Limbaugh, and the legion of right-wing, shrill blogger attacks; and GOP orchestrated senate attacks on the public option, than it has to do with Obama the politician. Obama desperately needs to bag a victory on health care reform. He's staked his administration's political fate on it. Polls show that his approval ratings have continued to plunge. And he's heard the grumbles of progressives and liberal Democrats go from hushed whispers to a loud roar that he is way too quick to make nice with the GOP on comprehensive heath care reform, and other key issues.
Obama will face his greatest challenge when the final health reform bill is delivered to his desk without a public option feature. That's a true public option and not a vague, ill defined, and unworkable "trigger" public option or even vaguer, unfunded, unregulated, and untested plan for health care cooperatives.
Put simply: Will he sign the bill? There's already much speculation and debate about that. Let's put that to rest here. He will sign it, and he will declare it the greatest victory for health care reform since LBJ inked Medicare into law four decades ago. Politically, it will satisfy few. Conservatives will still scream that it's a step down the road to socialized medicine. Progressives will scream that it does too little to ensure that the 45 to 50 million uninsured have affordable, quality medical care, and provide any real watchdog check on Big Pharma to make sure they drop costs, and keep them dropped on prescription drugs.
The government health insurance option was the only real hammer to cajole the pharmaceuticals and health care insurers to keep the drug costs down, reduce their obscene profit rake-offs, deliver better services, eliminate the endless dodges that insurers use to cherry pick only the healthiest and most profitable patients, and make some dent in the millions of uninsured. Unfortunately, the option won't be there at the end, Obama's lip-service to Congress notwithstanding.
Earl Ofari Hutchinson is an author and political analyst. His forthcoming book, How Obama Governed: The Year of Crisis and Challenge (Middle Passage Press) will be released in January, 2010.