Published on
The Guardian/UK

We Want the Public Option

Obama must retain a 'public option' for healthcare reform or he risks a massive backlash from the Democratic grassroots

When Barack Obama speaks before Congress on healthcare tonight, he'll either mention a public option or he won't. The calculus involved in making that decision will have nothing to do the politics of healthcare – sadly, the public option was an early casualty in the battle for control of K Street lobbying money. As far as the administration is concerned, it's just a matter of who breaks the bad news to grandma.

The neoliberal White House chief of staff Rahm Emanuel, the architect of Nafta, auctioned off most everything of value in a healthcare reform package long ago. Hospital profits, doctors' profits, pharmaceutical profits, insurance company profits, all guaranteed to go up, up, up for the next decade – so long as their lobbying money stayed in Democratic coffers.

And who gets stuck with the bill? Well, that would be the middle class consumers, forced to buy junk health insurance they can't afford to use. Dreams of a second New Deal reduced to a massive transfer of wealth to the private insurance industry, with nary a cost control in sight.

Whether it goes down as the White House plans is another matter entirely.

Since President Obama took office, his charm and confidence have allowed him to successfully put lipstick on one neoliberal pig after another: the bank bailout, the big coal bailout, the IMF bailout, escalation of the war in Afghanistan, expansion of the defence budget. All done in the name of "bipartisanship," which is popular in theory with the public but hardly necessary with a strong Democratic majority. It's largely been used as an excuse to backtrack on promises made to the progressives who put him in office, who continue to be held in curious contempt by the White House.

Through all these disappointments and failures, the president's popularity has held. But that may be coming to an end.

When Barack Obama ran for office in 2008, he truly did awaken a hope inside of people. They voted for "change" in 2008, and that really meant something to them. It is independent of Obama himself, and can't easily be so easily manipulated as cynical DC operators suppose. His supporters gave him a pass on the bank bailouts and the betrayal of labour and his failure to close Guantanamo Bay, not because they were easily flim-flammed but because they were holding out hope for health care reform.


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While the impact of the bank bailout was remote for most, an abstract outrage, health care is immediate. The only people who think they have good insurance in America are the people who haven't used it. The UnitedHealth chief executive has $700m in unexercised stock options specifically because the company turned down some kid for the transplant of some vital body part. Everyone hates the insurance industry. Everyone wants delivery from their banal, bloodless, bureaucratic evil that manifests itself in the life of someone they know.

The White House game plan for managing public disenchantment has relied on two PR strategies: the memory hole and the yo-yo. In the first, the public gets upset about something – say, the enormous AIG bonuses paid by taxpayers. The President says something stirring about clawing them back, the House does its Mr Deeds Goes to Washington number and passes something populist, and by the time it dies in the Senate the public has forgotten about it – swept down the memory hole.

In the yo-yo, some anonymous administration official says that military tribunals will continue – the Democratic base goes nuts, and the President reassures everyone that he still intends to put a stop to them. Just as the public is catching its breath, three anonymous administration officials tell the Washington Post that the commissions will continue, they'll just be "new and improved." The base goes nuts again, and then some cabinet secretary tells the New York Times else that it isn't true. Finally, when the public tumbles to the fact that it's been a done deal for a while, everyone is exhausted and the White House calls it "old news," sparing themselves the impact of an unpopular announcement.

I'd say we're mid-yo right now. The lack of direction, the strategic gaffs and the scrambling evident in the White House are probably happening because they are coming to grips with the fact that they don't have a clear shot at the memory hole. Nobody is going to forget this one, ever. So they're going to try and bank it off the Republicans again. Obama will continue to express his "support" for a public option while stressing the virtues of whatever Rahm Emanuel didn't auction off to Wellpoint. Then they'll all blow on the dice, blame the GOP and hope that their luck holds one more time.

Spoiler alert: it won't hold. It was Obama who promised his supporters delivery from the tyranny of private insurance companies, and it is Obama who will bear the burden of the public disappointment when "health care reform" turns into a massive bailout of the private insurance industry.

Whether the President mentions the public option tonight is moot. More important is whether he realises he's on the road to a one-term presidency and decides to change course before it's too late.

Jane Hamsher

Jane Hamsher is the founder of Her work has also appeared on The Daily Beat, Common Dreams, AlterNet, The Nation and The American Prospect.

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