America-stan: The Progressive Movement Neuters Itself by Supporting "States' Rights" to Opt Out of the Public Option

03/18/2010 05:12 am ET | Updated May 25, 2011
  • Miles Mogulescu Entertainment attorney, producer, writer and political activist

It's starting to amaze me how far some so-called "progressives" are willing to bend over to get something called "health care reform" passed, no matter how compromised and feeble.

Here's how they've proceeded:

First, take the progressive goal for the past 70 years--universal single payer for all--off the table from day one, even as a negotiating position.

Second, put in its place a mandate that the uninsured must buy health insurance or be fined by the federal government, but combine it with the right to buy a so-called "Public Option" instead of private insurance. Present this "Public Option" to progressives as a robust alternative to single payer that would insure over 125 million Americans and have the market-power to lower health care costs. By taking single payer off the table, make this the default left-wing of the health care debate against which insurance companies and their right-wing allies can focus the brunt of their attacks.

Third, in the face of these attacks, allow the Public Option to be watered down to a point where, according to the Congressional Budget Office, in its most "robust" form (as proposed by House "progressives" and Sen. Jay Rockefeller) it will only cover 5 million to 10 million Americans, and in its less robust form (as in the current House bill and the Senate HELP Committee bill) will cover exactly Zero Americans, and, in either case, will have no material effect in lowering health insurance costs. (For more details on how we arrived at this "Public Option in Name Only," see the Postcript at the end of this article.)

Finally, some "progressives" are supporting a proposal that any state that wants to may opt out of this "Public Option in Name Only," thus denying its citizens the modest benefits that Public Option supporters argue it will serve. "Progressives" like Howard Dean and former Move On leader Tom Matzzie are supporting this approach.

This last idea is the most pathetic of all, caving into conservative "states rights" framing of social and economic issues, taking us back to the pre-New Deal era when corporate interests tried to block federal regulation of the economy and the establishment of a social safety net by claiming it violated the Constitution; or the 1950s and '60s when Southern states claimed the right to ignore Federal civil rights laws.

The states and the federal government each have their rightful place. But this is not America-stan, ruled by a collection of local war lords, like Texas Gov. Rick Perry who hints at secession, or Mark Sanford who tries to turn down Federal stimulus money when he's not busy "hiking the Appalachian Trail." In a modern society, certain economic regulations, social safety net provisions, and basic civil rights protections must be national in scope to be effective.

If progressives accept the idea that states can opt out of the Public Option, Republicans will soon be proposing that states can opt out of Medicare, Social Security, the minimum wage, and civil rights laws. This is really bad precedent.

How low can "progressives" sink? Progressives have to stop being so desperate that they will accept almost anything, no matter how bad, even Republican "states rights" framing of issues, to pass something called "health care reform".

Otherwise, not only will we get a really bad health reform bill. We'll lose the argument to fight for other progressive reforms.

...with a debt of gratitude to Dr. Kip Sullivan, a long-time fighter of universal health care, whose article "Bait and Switch: How the Public Option Was Sold" is a must-read for anyone who wants to understand how the "Public Option" became the "Public Option in Name Only."

The "Public Option" was initially proposed by Yale political scientist Jacob Hacker and Campaign for America's Future leader Roger Hickey as a more politically "pragmatic" alternative to the long-time progressive goal of establishing universal single payer health care (as though insurance companies and their paid-for Congressional allies wouldn't fight against a robust Public Option as hard as they would fight against Medicare for All).

Hacker and Hickey laid out 5 criteria that they argued were essential to the success of the Public Option.

1. The PO had to be pre-populated with tens of millions of people by shifting all or most uninsured people, as well as Medicaid and SCHIP enrollees, into the PO, so like Medicare it would represent a huge pool of enrollees on day one.

2. Only enrollees in the PO, not in private insurance, would be eligible for government subsidies.

3. The PO and its subsidies would be available to all nonelderly Americans (not just the uninsured and employees of small businesses).

4. The PO would pay Medicare reimbursement rates.

5. The insurance industry had to offer the same minimum level of benefits that the PO offered.

If these criteria were met, the Lewin Group (a subsidiary of health insurance giant United Health) projected that the Public Option would enroll 129 million Americans, have overhead of 3%, pay hospitals 26% less and doctors 17% less than the private insurance industry, and have premiums 23% below the private insurance industry average.

That was the "bait." Then came the "switch." (I'm not saying that the initial supporters of the Public Option intended to pull a bait and switch. They honestly believed they were following the best strategy. I'm saying the effect of their strategy was a bait and switch, and now they're not owning up to it.)

The so-called "robust" Public Options that are still under consideration in Congress (i.e. the Senate HELP Committee bill and the tri-committee House Bill) only meet the last of the 5 criteria for an effective and robust Public Option and reject the first four criteria. The puny Public Option proposals that are still on the table are not pre-populated; subsidies go to both the Public Option and private insurance; large employers are barred from buying into the Public Option; and the Public Option is not allowed to use Medicare rates but must instead negotiate rates on a provider-by-provider basis. (Sen. Rockefeller's Amendment, which was voted down in the Senate Finance Committee, and the proposals by the House Progressive Caucus which are not in the bill reported out of the House Committee, propose that the Public Option could pay Medicare rates plus 5% for the first 2 years of its existence).

As a result, contrary to the Lewin Group's projections for the original "robust" Public Option proposals, the Congressional Budget Office projects that the Medicare plus 5% version of the Public Option would enroll less than 5% of the non-elderly population, while the version that doesn't use Medicare rates at all would enroll exactly 0 members, and in either case, would have a negligible effect on insurance premiums.

This isn't a "robust" Public Option. It's a puny and neutered Public Option. It's a Public Option in Name Only.

Leaders of the Public Option movement are failing to level with their constituents, who are still hoping for a robust Public Option. There is no "robust" Public Option left on the table. If they want to argue that this small public option is better than nothing, that's fine. But it's intellectually dishonest to continue to claim that it's "robust"

Now some of these "leaders" want to take this puny Public Option in Name Only and reinforce the conservative "states rights" framing of issues by allowing states to opt out, just so they can claim a victory for the Public Option. This is truly sad.

POSTSCRIPT 2: A CHALLENGE TO ROGER HICKEY, RICHARD KIRSCH OR TOM MATTZIE FOR A FRIENDLY DEBATE ON WHETHER A "ROBUST" PUBLIC OPTION IS STILL POSSIBLE: I'd like to challenge my progressive colleagues who proposed taking single payer off the table and substituting a a "robust" public option (and who also write for Huffpo) to explain in Huffpo how there's any possibility left for a "robust" public option to be passed, and how any of the "public option" proposals still barely alive in Congress meet the criteria they themselves set out several years ago for what would constitute a robust and and effective public option. Better yet, let's go on "Countdown" or "The Rachel Maddow Show" and debate this.