Last Call

Nate Silver games out where health care reform goes from here with the public option all but dead.

Is the public option really dead? Probably.

Perhaps the better question is whether the public option was ever really 'alive', meaning that it ever had enough votes to pass both the House and the Senate. We estimated based on committee votes that a bill containing a fairly weak public option -- like the one approved by the House's Energy and Commerce Committee -- would be a favorite to pass the House but probably only by a slim margin, with between 220-225 votes for passage (a minimum of 218 are required). And arguably, the conditions have worsened somewhat for health care reform since the Commerce Committee's compromise passed on July 31st.

It's the Senate side, though, where the public option was encountering most of its difficulties. Only 37 Senators, according to the whip count at Howard Dean's website, were firmly on board with the public option, whereas at least a few Democrats (Mary Landrieu, Joe Lieberman, Kent Conrad) had stipulated their opposition to it. There were nevertheless a number of scenarios under which one can imagine a bill with a public option having passed -- Lieberman, Landrieu, et. al. might be nominally opposed to a public option, but is their opposition so firm that they would vote to filibuster any bill that contained one?

The White House has evidently concluded that this is a real threat. I don't see any real obvious reason to doubt their assessment. For those who have come to a different conclusion, I'm all ears -- give me a detailed, practical (not theoretical) scenario by which a bill containing a public option passes both chambers and gets the President's signature. But I don't see it.

I don't either, and the Democrats have gotten crushed in the PR battle. So now what?

Is a bill without a public option worth passing (if you're a Democrat)? From a near-term political standpoint, almost certainly yes. Bill Clinton suggested on Thursday that the President's approval rating would get a five-point boost the moment that health care legislation passed with his signature. I don't know if that's exactly right, but this is certainly a better scenario for Democrats than the world in which health care reform fails and they're getting blamed by pretty much everybody and have nothing much to run on in 2010.

From a long-term political standpoint, some of the less effective versions of the House and Senate bills could create problems for Democrats down the road. For example, I've argued that the compromise floated by Max Baucus's Senate Finance Committee could wind up making quite a few folks upset, since it contains rather ungenerous subsidies and an individual mandate but no public option and no true employer mandate. If your employer drops your health coverage a few years hence and you have to buy an expensive plan on your own without much help from the government, you're probably going to be fairly peeved about the country having spent $900 billion to put you in this predicament. Hopefully, if the Democrats are giving up on the public option, they're at least getting something for their willingness to compromise, such as a stronger employer mandate and more aggressive regulations on insurance premiums.

Forget politics for a moment -- what about from a policy standpoint? The fundamental accomplishments of a public option-less bill would be to (1) ensure that no American could be denied coverage because of a pre-existing condition or because they became sick; (2) subsidize health insurance coverage for millions of poor and middle-class Americans.

These are major, major accomplishments. Arguably, they are accomplished at too great a cost. But let's look at it like this. The CBO estimates that the public option would save about $150 billion over the next ten years -- that's roughly $1,100 for every taxpayer. I'm certainly not thrilled to have to pay an additional $1,100 in taxes because some Blue Dog Democrats want to placate their friends in the insurance industry. But I think the good in this health care bill -- the move toward universal-ish coverage, the cost-control provisions -- is worth a heck of a lot more than $1,100.

I can see that. Nate goes on to say that progressives still need to fight for a solid bill that has no public option, but that's going to be all but difficult. As I've said time and time again, the goal for Republicans here is no bill whatsoever. They will not stop until it's dead, and it behooves Democrats to remember the reality of the situation.

But the Republicans and the insurance industry have proven they can definitely damage the bill, if not wound it badly. Getting it back on track is going to take a hell of an effort, and so far the Democrats have not shown they have what it takes.

We'll see. At this point something has to pass or Obama's done and so are the Dems. But if something DOES pass, the Republicans are ruined.

The real battle is about to get underway.