There can be little doubt that a significant enthusiasm gap played a major role in the outcome of the midterm elections. The liberal Democratic base is disappointed, and if there's one particular issue that underlies that disappointment it's probably the lack of a public option in the health care bill that was passed. Without a public option, Obama's plan amounts to a huge handout to the private insurance industry and will probably end up doing very little to rein in costs.
In his book Rebooting the American Dream, Thom Hartmann points out that Medicare -- because it is an existing program -- could be extended to all Americans via the reconciliation process. In other words, Medicare for all could be passed with 51 votes in the Senate (or even 50 plus the Vice President). Cenk Uygur made a similar argument here at the HuffingtonPost back in December, 2009.
Why not take another shot at it while we still have a Democratic Congress? Passage of a Medicare-based public option would be a dramatic victory for the liberal base that would do a great deal to restore enthusiasm and position the President for re-election.
More importantly, it would be good for the country and good for the vast majority of Americans. A viable public plan would keep the private health insurance industry in check, and would offer an increasingly powerful vehicle for controlling costs. Year after year, Congress votes to defer cuts in Medicare payments. It does this out of fear that doctors would refuse to see Medicare patients. There's an obvious fix for that: expand Medicare so that it becomes the most important game (if not the only game) in town. Every other industrialized country uses the power of government to keep health care costs under control. The United States simply can't afford to continue to buy into the ridiculous illusion that market forces alone will somehow halt the explosion of health care costs.
Once the new Congress comes to power in January, any chance for a major new initiative that will rally the Democratic base in 2012 is going to evaporate. Instead we'll get trumped up ethics investigations and legislative gridlock. Private insurers are already increasing premiums and dropping some types of policies in direct response to passage of the reform bill. If that trend continues over the next two years -- and it will -- Obama could be looking at an even bigger backlash in 2012.
Republicans have already made it clear that they will try to obstruct implementation of the reform plan by blocking allocation of the funds required to set up the programs. Likewise, there will be a lawsuit arguing that the requirement for everyone to purchase insurance is unconstitutional. Neither of those approaches would be effective against the expansion of Medicare because it is already in place and working.
Republicans are going to play hardball starting in January; no amount of appeasement over the next two months is going to change that. Now would be a good time for the Democratic party to show it has some backbone and that it is the party that is prepared to fight for the interests of average Americans.
Passing a Medicare-based public option would give American families the health care security they deserve. The task might actually be made easier by the fact that a number of conservative "Blue Dog" Democrats lost to Republicans in the election and may now be more flexible in how they cast their final votes. Pelosi, Reid and Obama should take full advantage of this absolute last chance to get a public plan in place.
Martin Ford is the author of The Lights in the Tunnel: Automation, Accelerating Technology and the Economy of the Future (available from Amazon or as a FREE PDF download) and has a blog at econfuture.wordpress.com.