Whittling Away At Health Care Reform

The last couple of days haven't been very kind to supporters of a strong public option health plan, including bloggers of the left, some members of Congress and, apparently, most Americans.

Wednesday evening, Politico's Mike Allen and Jim Vandehei wrote

Obama will address a joint session of Congress on health care reform in prime time on Wednesday, Sept. 9, a senior official tells POLITICO, and the president plans to give lawmakers a more specific prescription for health care legislation than he has in the past, aides said.

And although House leaders have said their members will demand the inclusion of a public insurance option, Obama has no plans to insist on it himself, the officials said....

On health care, Obama’s willingness to forgo the public option is sure to anger his party’s liberal base. But some administration officials welcome a showdown with liberal lawmakers if they argue they would rather have no health care law than an incremental one. The confrontation would allow Obama to show he is willing to stare down his own party to get things done.

“We have been saying all along that the most important part of this debate is not the public option, but rather ensuring choice and competition,” an aide said. “There are lots of different ways to get there.”

(Can anyone say Sister Souljah?)

A couple of hours earlier, firedoglake's Jane Hamsher reported

My colleague Dana Bash and I have learned from a source, each one of us, that this White House right now is very quietly in serious conversations with Republican Senator Olympia Snowe, a key moderate.

She is basically the last Republican out of those gang of six senators who have been negotiating, really the last Republican that has an open line to this White House right now.

What we're hearing that she's talking about with White House staff is sort of a scaled-back bill that would focus on insurance reforms that both sides could agree to, but would not have a full public option, instead, would have a so-called trigger. What that means in layman's terms is basically that the insurance companies would have a couple of years to make some dramatic changes.

If they do not make those changes, then a public option would be triggered. So, it would be used down the road. They would hope that this would appease liberals by saying it's not completely off the table. And the big hope is that this could bring along another moderate Republican, like maybe Susan Collins of Maine, some conservative Democrats, like Ben Nelson and Mary Landrieu in the Senate, who don't want a public option, but would sort of potentially be open to a trigger like this.

Thursday, The New York Times observed

With Congressional Republicans standing almost unanimously in opposition to the Democratic approach, the target now for Mr. Obama is primarily a handful of moderate Democrats and the one Republican who seems open to a deal, Senator Olympia J. Snowe of Maine.

“It’s so important to get a deal,” a White House official said, speaking on the condition of anonymity in order to be candid about strategy. “He will do almost anything it takes to get one.”

The Washington Post reported Wednesday that Senate leaders (presumably Democrats)

are rethinking their strategies on the issue. One option, leading Democrats said Wednesday, is to tailor a bill to the demands of Sen. Olympia J. Snowe (R-Maine), a key moderate who has displayed the most willingness to continue negotiating with Democrats.

Another option, lawmakers said, is to attempt to make any package that comes to the Senate floor more attractive to Republicans by including tighter cost controls and slowing the pace of providing coverage to the 47 million Americans who have no insurance.

This evidently mirrors (coincidence? I think not.) thinking in the White House, which, according to Ezra Klein Wednesday, falls along two lines:

The first camp could be called "universal-lite." They're focused on preserving the basic shape of the bill. They think a universal plan is necessary for a number of reasons: For one thing, the insurance market regulations don't work without universality, as you can't really ask insurers to offer standard prices if the healthy and the young don't have to enter the system. For another, it will be easier to change subsidies or improve the benefit package down the road if the initial offerings prove inadequate. New numbers are easier than new features. Creating a robust structure is the most important thing. This camp seems to be largely headed by the policy people.

The second camp is not universal at all. This camp believes the bill needs to be scaled back sharply in order to ensure passage. Covering 20 million people isn't as good as covering 40 million people, but it's a whole lot better than letting the bill fall apart and covering no one at all. It's also a success of some sort, and it gives you something to build on. What that sacrifices in terms of structure it gains in terms of political appeal. This camp is largely headed by members of the political team.

These latter two analyses omit discussion of one option: the public one. That's not surprising, given indications that President Obama, who has spoken several times to ranking Senate Finance Committee member Charles Grassley of Iowa is partial to the Senate bill.

You know Chuck Grassley, member of the Gang of Six, who has written "The simple truth is that I am and always have been opposed to the Obama Administration's plans to nationalize health care. Period."

Now all the talk is of Obama negotiating with Maine's Olympia Snowe, another Repub member of the Gang, presumably to bargain away the public option in favor of ineffectual co-operatives or the chimera of a trigger provision. In a Congress with a heavy majority of members of the President's own party, that is hardly leadership. Unless, of course, it is what Mr. Obama and Mr. Emanuel had in mind the whole time.