10/21/2009 05:12 am ET | Updated May 25, 2011

The Simplest Thing

I really do admire President Obama for having the courage to make health care reform his top priority when he knew in advance how difficult it would be to pass. That took a lot of guts, and he should be congratulated for it. And I really do have genuine sympathy for White House staffers and Congressional leaders trying to work their way through the incredible complications on this issue to find the sweet spot for passing a bill. This is a massively complicated issue, with a new minefield around every bend. The fight over the public option has obscured all the rest of it, but health care reform is a monster of an issue: how do you make the subsidies for lower and middle class folks affordable without breaking the bank? How do you adjust Medicare rates and Medicaid formulas and provider reimbursements in a fair way? How do you re-structure financial incentives to encourage more primary care physicians without penalizing the specialists too much? How do you find a path through all the special interest roadblocks thrown in your way?

Questions like these, and a few hundred more, make the passage of any major health care bill as difficult as anything a President could ever take on -- it is just landmine after landmine. From what I can tell, the Obama team hasn't done a bad job of navigating their way through to a solution on many of those quiet but really important issues. Again, my congratulations.

In the end, though, health care reform will live or die on whether the White House, Nancy Pelosi, and Harry Reid can figure out a way around the massive barrier in the middle of the road, the public option. Progressives are demanding it, conservative Democrats don't want to do it, Senate procedural rules make it complicated, so it's difficult to figure out what to do. And I fully understand the political imperative to get something passed.

Here's where I get confused, though. We have always known that passing any health care bill would be tough, but it has become increasingly clear as we get closer and closer to an end game that the easiest, simplest, least painful path is to actually go ahead and do what the President has proposed, which is to pass a bill with the public option.

Look at the facts that we are dealing with:

  • There is a very big and very solid core group of members in the House (way more than enough to block a bill from passing) who have pledged multiple times in writing to only vote for a bill with a public option.

  • That group in the House is backed up by an extremely determined activist core from the netroots, and increasingly intense organizations like the AFL-CIO,, and Democracy for America.
  • A majority of House members are on the record in favor of the public option.
  • While there are procedural issues to be resolved in the Senate, many of the top experts on Senate rules are saying that the public option can be included in a reconciliation bill which only needs 51 votes. Such a bill could be combined with a second bill to deal with the less controversial issues that can't be included in reconciliation.
  • While some of the most conservative Senate Democrats want there to be a bipartisan bill, which would require no public option, there are not enough of them to stop a bill being passed on reconciliation. In fact, there are now 51 Senators on the record in favor of the public option.
  • Okay, stay with me now: ditching the public option would mean a massive, ugly civil war with House progressives, most of whom will be feeling very gun-shy about abandoning their written pledges to oppose any bill without the public option. Keeping the public option would require dealing with some unhappiness from some conservative Senators, and might require a procedural move or two that would be complicated.

    Which approach sounds easier to get done?

    But conventional wisdom insiders have been telling each other for a long time that there is no way to pass a public option, and that has made White House staffers and legislative leaders have a hard time seeing what is becoming the honest truth: passing a bill with the public option is not only possible, but the easiest way to a victory.

    Maybe there is something I don't understand here -- it wouldn't be the first time. But as someone who passionately wants to help the White House pass a health reform bill, it seems pretty clear which way to go. I will admit it would not be simple or smooth, but that civil war scenario of dropping the public option would be a lot worse.

    Let's get this train moving down the most direct path to victory.