We Demand, Maybe

On his PlumLine Thursday, Greg Sargent wrote hopefully:

In a letter delivered to the White House moments ago, the two leaders of the bloc of House progressives bluntly told President Obama that they will not support any health care plan without a public option in it — and demanded a meeting to inform him face to face.

The letter was signed by Lynn Woolsey (D.-CA.) and Raul Grijalva (D.-AZ.), leaders of the House's Progressive Caucus. It termed any bill without "a public option built on the Medicare provider system and with reimbursement based on Medicare rates-not negotiated rates" as "unacceptable"- and noted it must be available immediately "and not contingent on any trigger."

The denunciation of the "trigger" concept is welcome news, and significant- up to a point. The progressives stop short of pledging to vote against any bill which does not include the relevant provision, instead calling such proposed legislation "unacceptable."

From thefreedictionary.com:

unacceptable - not adequate to give satisfaction; "the coach told his players that defeat was unacceptable"

To continue the analogy because (sarcasm alert) sports analogies are, oh, so unpretentious:

Coach Smith (what could be more typically American than Smith?) of the Chicago Bears tells his players that defeat in the upcoming game is "unacceptable." They lose, anyway. Does Coach Smith resign; appeal the outcome of the game; launch an assassination plot against the lead official? The third option is no more unlikely than the first two. "Unacceptable" has become acceptable.

More significant is Sargent's fear that

Should Obama jettison the public option, progressives will come under tremendous pressure to back the plan anyway. White House advisers will likely insist that liberals mustn’t deny the president a historic victory and enable a defeat that could cripple the first African-American presidency.

Could Sargent have been referring to this? Glenn Thrush of Politico wrote Thursday

The Congressional Black Caucus -- alarmed by reports that President Obama may plan to ditch the public option and reduce the scale of health care reform -- is pre-emptively warning the president to express his "unwavering support" for the progressive provisions in his speech next week.

The letter read in full:

Dear President Obama:
We eagerly anticipate your address before Congress next week regarding the urgent need to reform America’s ailing health care system. As the Members of Congress who represent the men, women and children who are disproportionately under- and uninsured, and whose health and wellness have suffered because of the numerous gaps in our nation’s health care system, we are deeply concerned about the current discussions surrounding health care reform and the possibility that current components of the bill – such as a robust public option and myriad health disparity elimination provisions – may be stricken in order to lower its cost to about $500 billion. We sincerely hope that you stress unwavering support for the following in your remarks:
1. An unwillingness to reduce the current costs of the health care reform bill. Despite misinformation about health care reform, such drastic cuts are unnecessary. Many of the nation’s health and health care experts concur that a meaningful, upfront investment is necessary to adequately mend the nation’s broken health care system. The TriComm bill (H.R. 3200), as you know, is budget neutral; in its current state, it is reflective of health legislation that is not only medically and socially appropriate, but fiscally sound. Reducing the overall cost of a budget neutral bill is therefore unnecessary and not a strategy that we do or can support.
2. A strong public health option that will allow the nation’s more than 46 million uninsured Americans – more than half of whom are people of color – to finally have access to affordable, meaningful health care coverage no later than 2013. As you know and we have firmly noted throughout the health care reform debate, a robust public option not only will play a pivotal role in our collective efforts to eliminate uninsurance – a public health challenge that detrimentally affects millions of hardworking, innocent Americans – but also in our efforts to ensure that every American citizen, regardless of race, ethnicity, geography or gender, has affordable access to meaningful, reliable health care treatments and services when needed. Thus, we firmly believe that the extraordinary benefits of a robust public option to the health and strength of this nation should, and do, outweigh the immediate, upfront costs associated with creating it.
3. A strong and demonstrative commitment from the White House to, in the days and weeks to come, use health care reform to achieve health equity. This will include not only ensuring the passage of existing health disparity elimination provisions – such as those around data collection, workforce diversity and community health workers – but also supporting stronger provisions, such as those included in Titles I, II, III and IV of the Health Equity and Accountability Act of 2009 (H.R. 3090). These measures are necessary to address the root causes of the health inequities that disproportionately and detrimentally affect racial and ethnic minorities, women, rural Americans and Americans within the U.S. Territories. These provisions are integral to efforts to ensure that as health care reform proceeds, we succeed in closing the gaps in health care that are independent of an insurance coverage, but that millions of Americans fall through and suffer from every day.
4. Inclusion of provisions that will ensure equity and parity for the American men, women and children in the U.S. Territories. The nearly 5 million Americans who live in the U.S. Territories should benefit from health care reform in a manner that is equitable to those Americans who live within the 50 states and in the District of Columbia. This is especially pertinent, given that so many of the nation’s worst health and health care trends are in the U.S. Territories. Therefore we urge you to, reiterate your commitment to ensure that these American citizens receive equal treatment under the health care reform bill..
5. Strong consideration of a trigger that will allow for the savings from prevention and other provisions in H.R. 3200 to replace the current pay-fors that have been identified. This strategy will not only allow the realization of true cost savings of prevention, health disparity elimination and other provisions, but it also will provide an avenue through which the savings generated can replace current pay-fors and/or be used to add important services and programs not currently offered because the costs are deemed too high.

We want to assure you and your Administration that the members of the Congressional Black Caucus are committed allies and partners in the fight to reform America’s broken health care system. Together we can seize this unique moment in our nation’s history to ensure that we not only reform our nation’s health care system, but that we transform it in a manner that eliminates uninsurance with a robust public option, achieves health equity for all Americans, and makes us – as a nation – healthier and stronger.
We appreciate your attention to this letter and look forward to working with you on this critically important legislation.

With regards, Congresswoman Barbara Lee
Chair, Congressional Black Caucus

Forget for a moment the reassuring words "we want to assure you and your Administration that the members of the Congressional Black Caucus are committed allies and partners int he fight to reform America's broken health care system."

Look instead at two other aspects of the letter:

1) Emphasis. After rightly urging the President to state "an unwillingness to reduce the current costs of the health care reform bill," the CBC notes the importance of providing a public option for uninsured Americans, "more than half of whom are people of color;" of health care reform "to achieve health care equity" and provisions "to address the root causes of the health inequities that disproportionately and detrimentally affect racial and ethnic minorities, women, rural Americans, and Americans within the U.S. Territories; and of a strategy which will include "health disparity elimination and other provisions."

2) Exclusion. Where is there any indication that members of the CBC would oppose a bill without a public option which would omit a trigger (which probably would result in no public option, now or later)? Nowhere- instead they "sincerely hope" the President will "stress unwavering support" for the positions they, justifiably, advocate.

The support of the Congressional Black Caucus for a "strong public option" (and who could be against strength? and for the needs of its constituents is laudatory. But it doesn't go far enough, suggesting, as Sargent fears, that "White House advisers will likely insist that liberals mustn’t deny the president a historic victory and enable a defeat that could cripple the first African-American presidency."

Is there any reason to believe invoking this race card wouldn't work? President Obama will not stoop that low; he has Chief of Staff Rahm Emanuel to play the bad cop in the "good cop, bad cop" routine. And much of the mainstream media, which will readily, and lustfully, argue inaccurately that defeat of a minimalized health care bill is a devastating blow to the first black President.