Depressed About the Loss of the Public Option? Read This

Some liberals and progressives, among others, might be feeling beaten and depressed today about the loss of the public option or the Medicare buy-in “compromise” that was to replace it. Some might even think that the current package of reforms isn’t worth passing without a public option, that they should be rejected with the hope of passing something more ambitious in the future.

There is no such future. The health reform we’ll get in this Congress is the best that can be obtained. It is better than the status quo. It will assist millions of people. It provides the best hope of controlling costs (though it does not guarantee success in doing so). Those who supported health reform with a public option should still support reform without it. Wishing for its failure thinking that would set the stage for something better would be a mistake.

Ezra Klein said it best in an early November post:

Failure does not bring with it a better chance for future success. It brings a trimming of future ambitions.

Truman sought single payer. His failure led to Kennedy and Johnson, who confined their ambitions to poor families and the elderly… [Later came] Clinton, who again sought to reform the system by putting private insurers into a market that would be structured and regulated by the government. His failure birthed Obama’s much less ambitious proposal…

Failure does not breed success. Obama’s defeat will not mean that more ambitious reforms have “a better chance of trying again.” It will mean that less ambitious reformers have a better chance of trying next time.

Conversely, success does breed success. Medicare and Medicaid began as fairly limited programs. Medicaid was pretty much limited to extremely poor children and their caregivers. Medicare didn’t cover prescription drugs, or individuals with disabilities, or home health services.

But once the programs were passed into law, they were slowly and continually improved. They became more expansive, with Medicaid growing to cover not only poor families but also poor adults… Medicare was charged with covering people with long-term disabilities, and it was eventually strengthened with a drug benefit, more preventive coverage, the option of supplementary plans and much more.

It is not hard to imagine health-care reform following a similar path…

But all that is predicated on the creation of this new, flawed, insufficient system. As any scientist will tell you, it’s much easier to encourage something to evolve in a certain direction than it is to create it anew. The idea that a high-profile failure in a moment where a liberal Democrat occupies the White House and Democrats hold 60 seats in the Senate for the first time since the 1970s will encourage a more ambitious success later does not track with the history of this issue, nor with the political incentives that future actors are likely to face. If even Obama’s modest effort proves too ambitious for the political system, the result is likely to be a retreat towards even more modest efforts in the future, as has happened in the past.

Failure would be more than a political loss. It would be a loss felt not just by Democrats but by all Americans who use and pay for health care. It would mean loss of the possibility of the evolution toward reform we need. The better future health system you may envision begins with this bill, flawed as it may be, and even without a public option.

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