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Few plot turns in the bodice-ripper known as health reform have dismayed me as much the heavy breathing between President Obama and Sen. Olympia Snowe, R-Maine. After Sen. Charles Grassley, R-Iowa, made clear he wouldn't support anything called health reform from Democrats, the White House apparently concluded that its quest for a "bipartisan" bill depended entirely on winning token GOP support from Snowe. All the Obama administration had to do was abandon any hope of creating a "public option" government health insurance program—the single most effective way to curb medical inflation and low-income consumers' most reliable sanctuary from private-sector chicanery.
Snowe's alternative, a public option "trigger," is widely being described as one "version" of the public option that may emerge in the Senate bill. Under the proposal (formally known as the "safety net fallback plan") the public option would be created in any state that, after the implementation of health reform, failed to make private health insurance affordable to 95 percent of that state's residents. As is generally true with "trigger" proposals (especially when it comes to health care) the purpose is not to resolve an underlying disagreement but to paper over political differences. Triggers almost never get pulled.
How could Obama fall for Snowe's wiles? It's tempting to conclude that Obama is drawn to a fellow ditherer. (A constant Snowe refrain throughout the finance committee markup was that this darned bill was being pushed through so fast that just she didn't have time to make up her mind. Echoes of the president's Afghanistan policy?) A likelier reality is that Obama has let Chief of Staff Rahm Emanuel and senior adviser David Axelrod sell him on a belt-and-suspenders strategy that too hastily dispenses with any aspect of the bill likely to stir partisan opposition. I have my doubts that either Nancy-Ann DeParle, White House health reform director, or Rahm's brother Ezekiel Emanuel, a bioethicist currently serving as health policy adviser to White House budget director Peter Orszag, has worked very hard to counter political arguments against the public option with policy arguments in its favor. Neither DeParle nor Emanuel came into the White House with any great enthusiasm for expanding the government's market share in health insurance.
The irony, as I've noted here and there, is that even as government officials were concluding that a public option was simply too radical to contemplate, polls consistently demonstrated majority support for the idea (which was more than you could say for health reform itself). The public option even enjoyed reasonably strong support from Republicans, winning over a 47 percent plurality in a September New York Times poll and (when defined more narrowly as "available only to people who did not have a choice of affordable private insurance," as any enacted public option would likely be) a 56 percent majority in an October Washington Post poll. Doctors, who have every reason to fear a public option will lower their fees—that's partly what it's designed to do—nonetheless favor it by 63 percent, with another 10 percent saying they'd prefer going straight to single-payer.
It fell not to the Obama White House but to Sen. Chuck Schumer, D-N.Y., to take note of these realities and to dream up a plausible compromise. Schumer spoke more eloquently than anyone else during the finance committee markup about the necessity of creating a public option—its most stalwart proponent, Sen. Jay Rockefeller, D-W.Va., lacks Schumer's oratorical chops—and after it failed on a committee vote, Schumer kept his eye on the main chance. When Sen. Tom Carper, D-Del., floated the idea of allowing states to opt into a public option, Schumer, perhaps taking a leaf from Richard Thaler and Cass Sunstein's book Nudge, turned it around by crafting a proposal that would allow states to opt out. Majority Leader Harry Reid, D-Nev., took the idea and ran with it, and now he appears very close to lining up a filibuster-proof 60 votes, even though Snowe says she won't support an opt-out. Accounts vary as to what the White House has to say, but at best the president is taking a hands-off approach and at worst he's discouraging Reid's effort and won't abandon Snowe at the altar. A White House statement denies the latter but doesn't dispute the former.
What Obama isn't doing, maddeningly, is helping Reid twist arms; Jonathan Cohn reports on his New Republic blog that one senior Democratic staffer told him on Oct. 25 that Reid had not yet received any "signal" of support from the White House. At Politico, David Rogers argues that Democrats in Congress have a more urgent political need than the White House to include the public option, because they'll get killed in 2010 if voters can't afford newly mandatory health insurance premiums.
The White House, by contrast, doesn't face voters until 2012 and is therefore more interested in cozying up to Snowe to minimize the possibility of a potentially crippling legislative defeat. If Rogers is right, then the White House is being amazingly myopic. Should health reform spark a nationwide revolt, most vilification will be directed at Barack Obama. He can't afford not to sweat the details of this bill. It's time to kiss Olympia Snowe goodbye.
Update, 5:15 p.m., Oct. 26:Reid made it official this afternoon: He will send to the Senate floor a health reform bill containing the "opt out" version of the public option. (Scroll down for the video.) Reid is asking the Congressional Budget Office to estimate savings from the provision. He will not ask the CBO to do the same for Snowe's "trigger" provision. "I spoke to Olympia on Friday," Reid said. "I talked to her on a number of occasions. And at this stage she does not like a public option of any kind." Later, Reid praised Snowe as "a very good legislator" but said, "I'm disappointed that the one issue, the public option, has been something that's frightened her." In a statement, La Snowe replied that she was "deeply disappointed with the majority leader's decision to include a public option as the focus of the legislation." (Incidentally, Newsweek's Howard Fineman has an excellent column asking who died and made Snowe queen.)
After Reid spoke, the White House issued a statement declaring the president "pleased that the Senate has decided to include a public option for health coverage, in this case with an allowance for states to opt out. As he said to Congress and the nation in September, he supports the public option because it has the potential to play an essential role in holding insurance companies accountable through choice and competition."
Well, I'm glad he's pleased. You know who else is pleased? My 80-year-old mother. But she's not well-positioned to make it happen. Get back to us, Mr. President, when you're ready to roll up your sleeves. Better yet: Don't get back to us. Just do it.
Senate Majority Leader Harry Reid's statement about an opt-out public option.
E-mail Timothy Noah at email@example.com.