No Public Option

As many progressive/liberals are apoplectically coming to realize, we're not going to get a so-called public option as a part of this year's health care reform. The long and short is there simply does not currently exist the political or public will in America for anything remotely resembling a single-payer health system. Unfortunately, and not coincidentally, for many advocates on either side of the issue the public plan has become synonymic with a single-payer plan. Americans by and large are skeptical of bureaucracy. The taken hold perception that a public plan would directly or indirectly facilitate creation of a new, amorphous, hulking bureaucratic entity whose sole purpose would be to administrate the most intimate and vital aspect of citizen's lives - - their health - - evidently strikes many Americans as far too scary an unknown unknown to wade into. That these fears set aside those other, ingrained hulking bureaucracies Americans have come to take for granted, Social Security, Medicare/Medicaid and the VA, is of apparently little significance to a good percentage of the public. In any case, the vitriolic nature of today's political discourse does not favor the adoption of new large scale social engineering programs. We may wish it were otherwise but wishing won't change current political realities. Consequently, it's but an exercise in wasted words and energy to spend much time casting blame towards the administration and/or congress for failing to convincingly advocate for a public option; single-payer and it's surrogates were a non-starter in this debate from "go" and to think otherwise is to be in denial. Sorry to break it to ya, sad but true.

If we'll recall, this was a key differentiator between Hillary Clinton's approach to health care reform and Barack Obama's: Hillary suggested we ought to move directly towards a single-payer system while Obama suggested that the more incremental goal of increasing overall coverage and initiating insurance reform was the more politically viable approach given contemporaneous ideological schisms. Progressives may argue that Obama has created a self-defeating, self-fulfilling prophecy for his reform plans by not using his bully pulpit to at least attempt to convince Americans of why achieving a single-payer health care system would be a good thing. But this reasoning fails to take into account the fragile governing coalition the Democratic party has forged over the past two election cycles to achieve it's current congressional majority. A coalition where so-called 'blue dog' democrats, having inherited the mantle from the 'Reagan Democrats' of yore, represent largely center-right constituencies who while perhaps arguably more socially liberal than other conservatives nonetheless remain fundamentally small-government conservatives. I sense that the administration has been acutely aware of these limitations from the beginning and more or less has used the public option as a bargaining chip to be taken on or off the table to appease, garner momentary support or relieve pressure from whichever side necessary to methodically jimmy forward the ultimate plan.

In an earlier post I commented that, although he had given little indication of what bottom line reforms must be in the health plan he'd ultimately sign, my gut feeling was that generally speaking Obama hoped to move the US towards a Swedish model of social democracy. However, I've come to realize that my analysis may have been a thousand or so kilometers off base; I agree with Paul Krugman that as concerns health care, the reform we're likely to get in the end will mirror Switzerland's approach to universal coverage. While I also agree with many of the points Timothy Noah makes in Slate about the need for some form of public subsidizing of universal coverage in order to avoid the unsavory scenario of the government compelling already cash-strapped families to purchase healthcare they can hardly afford, I'm confident the compassionate eggheads in the administration figured out a game plan for this long ago. Perhaps there's more to the cooperatives being discussed than meets the naked eye. In any case, if you ask me, the Swiss system sounds pretty darn good and a far better fit for the psyche of this country than either the UK or Canadian models. I think that many liberals/progressives choose not to acknowledge that for many Americans the choice to live as completely unencumbered by government as is socially prudent is what equates with freedom. This group of folks by and large are don't want ANYONE let alone government attempting to modulate their behavior. I may see this as just short of anarchy, but it should be crystal clear by now that a relatively high percentage of Americans genuinely believe a 'don't tread on me' view of personal freedom to be intrinsic of 'the American way." In light of of such polar opposed ideology, Swiss inspired health coverage, with its insistence that all citizens purchase health insurance from private providers (with the costs to the impoverished subsidized by government) seems to me the closest we'll get to universal health coverage anytime soon.

Hence, if all the sausage making and bluster surrounding the congressional debate is but so much kabuki theatre obscuring a mostly pre-envisioned outcome, it's possible this is why Obama appears unable to muster much enthusiasm for going through the motions of attaching himself to the less tractive aspects of the plan. So yes, Jon Stewart, maybe Obama is part jedi; it's possible he's five or six moves ahead of his critics on both sides of the debate. However, and to continue with the Star Wars reference, in my opinion what Obama still must learn in order to matriculate from mere knight to master jedi status is how to more effectively shape and influence public perception. I am concerned he and his key strategists are too smart for their own good by half; more often than is probably prudent given the (limited) intellectual capacity and emotional intelligence of the general public (oh I'm sorry was that elitist? it was? well deal with it p**ks!) , Obama seeks to sway with reason when good old-fashioned sincerely delivered passion is the weapon he ought pull from his quiver. In addition, I have expressed consistent concern that he has vastly overestimated his cache of political capital (ala Bush in his second term) and is as yet unclear about how to wield presidential power to fuel regeneration of such capital.

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Like apparently many other Obama supporters, I've often found his job performance thus far a bit less than inspiring. I keep expecting him to lay more of his cards on the table and take stands on important policy issues. Wholeheartedly championing principled positions is a big part of what I deem leadership and I've seen little of it thus far from our "Change we can believe in" president. I'm pissed that he's configured an administration where only he himself has enough wattage to sell policy. Although it may seem a counterintuitive argument to put forth, In today's short attention span media environment it's actually difficult to become overexposed; people can (and do) always click the channel and find one where politics isn't even remotely on the menu. Nevertheless this president gets trotted out day after day after day and his cool equanimity is wearing poorly over time, a classic case of a considerable strength doubling as a significant weakness. It's difficult to make news and grab people's attention when most messages are delivered with the same vacuous (sorry O!) semi state of alarm. Bush accomplished the feat of making news on demand by sending out charismatic, shameless minions who would say whatever necessary to underscore a point (think Rice's 'mushroom cloud' references or Cheney's WMD certitudes). The Obama administration too often risks coming off as undisciplined and underprepared because its group of independent minded, earnest seeming (eek!), thought provoking brainiacs are constantly going on Sunday talk shows showing off the wide variety of opinions and approaches to problem solving they presumably share with the president. Again, this is a display of strength as weakness. That Obama seeks and apparently is getting unfiltered and candid input from his staff is admirable; that he does not in the end demand consensus and constancy of message borders on a failure of human resource management.