Is the public option dead?

The White House reasserts its support for a government-run healthcare option, but signs point to critical condition

Published August 17, 2009 12:18PM (EDT)

Sunday, many media outlets were reporting that the public option might be on its way to an early death. Some Democrats and members of the Obama administration appeared to give indications that they were ready to drop the public option from proposed healthcare reform legislation in order to broker a compromise with Republicans.

Appearing on CNN's "State of the Union," Health and Human Services Secretary Kathleen Sebelius said, "I think there will be a competition to private insurers that really is the essential part, that you don't turn over the whole new marketplace [after health care legislation is enacted] to private insurance companies and trust them to do the right thing. We need some choices, we need some competition." She also told CNN's John King that a public option "is not the essential element" in a healthcare reform package.

The New York Times reported Sunday that numerous administration officials appeared to hedge on the public option over the weekend. On Saturday, speaking in Colorado, the president himself seemed to suggest that losing the favorite provision of his progressive base would not be a catastrophe, "The public option, whether we have it or we don't have it, is not the entirety of health-care reform," Obama said. "This is just one sliver of it, one aspect of it."

And it wasn't just the Obama administration that seemed to be downplaying the public option. Sen. Kent Conrad, D-N.D., said on Fox News on Sunday that a bill with a public option wouldn't ever make it to Obama's desk. “The fact of the matter is, there are not the votes in the United States Senate for the public option,” Conrad said. “There never have been. So to continue to chase that rabbit, I think, is just a wasted effort.”

But did the Obama administration actually change its position on the public option? The short answer: not really. As Time's Karen Tumulty points out, the Obama administration has never touted the public option as the only way to reform healthcare. Tumulty writes:

Obama has never presented the public option as anything other than a means to an end — one that he would be perfectly willing to achieve through other avenues if necessary. His goal is twofold: to provide a low-cost alternative to the private system that already exists and to assure competition in a health-care market where it is generally lacking. Though there are more than 1,000 private insurance carriers in this country, the dominant ones operate as a near monopoly in most states.

By last night, the administration was trying to clarify Sebelius' comments. The Atlantic's Marc Ambinder writes that an anonymous White House official told him that Sebelius "misspoke" when discussing the public option. Linda Douglass, director of health reform communications for the administration, also reiterated that Obama is still fully behind the public option and believes it's the best way to reduce healthcare costs and pressure insurance companies to enact reform.

"Nothing has changed," Douglass said in a statement. "The President has always said that what is essential that health insurance reform lower costs, ensure that there are affordable options for all Americans and increase choice and competition in the health insurance market. He believes that the public option is the best way to achieve these goals."

But there are some loud voices on the left making the case that Obama and progressive Democrats will not be able to appease Republicans regardless of how much ground they concede on healthcare reform and that Democrats must push forward with a public option. Former Democratic presidential candidate and Democratic Party Chairman Howard Dean said Monday that significant healthcare reform can only occur with a strong government-run option. "You can't really do health reform without it," Dean said of a public option.

Recently, New York Times columnist and Nobel Prize-winning economist Paul Krugman, argued that reform opponents are "unappeasable." Discussing the right's obstinacy to reform, Krugman said on MSNBC, "It's not actually about the end-of-life provisions. It's not about this specific thing in the bill. They're just going to grab onto anything and try to turn it into something awful.... It's not about the substance and that means that you can't actually satisfy the crazies by offering substantive concessions."

MSNBC host John Harwood then added, "I gotta tell you what a White House official told me today: 'Our problem right now is, if we tell some of the Republican opponents in the Senate, 'You can have everything you want in the bill,' they still won't vote for it.'"

By Vincent Rossmeier

Vincent Rossmeier is an editorial assistant at Salon.

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