Fighting For The Public Option

by publius

Scott Lemieux and Ezra Klein recently had a back and forth on whether a health coverage reform bill without a public option was worth supporting.  I agree with Klein on the merits, but it's a trickier question politically when you start viewing it through a game theory lens.

On the policy merits alone, the public option isn't the most critical part of the bill -- and its absence certainly doesn't justify rejecting the whole thing.  As Klein notes, the current reform plans include the public option only on the exchanges, which are currently limited to "the unemployed, the self-employed and small businesses."

The problem, though, is that conceding this point eliminates the public option's power as a negotiating chip.  If Democrats are going to give up the public option, they need to something real in return.  In this sense, adopting a position that the public option is non-negotiable could ultimately lead to a better bill (assuming it's a credible threat).

But blustering aside, the primary policy defense of the public option is not so much what it will do on Day 1, but what it will grow into.  And that's also true of the exchanges.  Regulating insurers is the most important short-term part of the bill (prohibiting pre-existing conditions, automatic renewal, etc.). 

But strong exchanges are arguably the most important long-term part of the bill.  Think of the New Deal legislation.  Its primary benefit wasn't so much its immediate effect, but its creation of infrastructure and institutions that grew into something much better.  That's sort of how I see the exchanges.  Once the basic institution is set up, it will get progressively easier to admit people in.  Its growth will also help gradually delink health care from employment in a politically easier way (that's essentially what Wyden's new bill would do -- it would inject the principles of his old bill into new, broader exchanges).

And as the exchanges grow, having a public option will be increasingly important.  But it's important to include the public option in the exchanges now.  Although I think it will be easy to progressively expand the exchanges ("let's allow group X to save money"), it might be harder to include the public option in the future because of ideological divisions on the issue.  In other words, the public option needs a 60 Dem Senate in a way that increasing the scope of the exchanges does not.  You can imagine the exchanges getting better regardless of which party controls Congress, but that's not true of creating the public option.

I'm not saying that Dems should fight to the death on the public option, but it's worth making some very serious noise about, both politically and policy-wise.

Comments

[Brett Bellmore]

"Think of the New Deal legislation. Its primary benefit wasn't so much its immediate effect, but its creation of infrastructure and institutions that grew into something much better. "

Yeah, that's what's got us frightened: That getting the public option will be rather like contracting cancer: Not so bad at first, but it will grow.

[Derek]

The incrementalism is wise because one of the biggest attacks the opposition makes is that Obama is going to cause people to lose the coverage they currently have (and most people currently have coverage through their employer). That's sort of what made Von's [crack]pipe dream about bi-partisan support for the Wyden-Bennett bill amusing. Why walk into that trap? Because the GOP is magically going to change their lines of attack? At least now, considering the fact the current plans go through great lengths to protect the currently insured, Obama can say the GOP is full of crap.

[cleek]

remember, with the GOP, "bi-partisan" = i get everything i want.

[C.S.]

So Brett, can we take it from you comment that you think that parts of the New Deal were cancers? Which parts, pray tell?

[jacksmith]

LEAD, FOLLOW, OR GET OUT OF THE WAY. (Thomas Paine)

We have the 37th worst quality of healthcare in the developed world. Conservative estimates are that over 120,000 of you dies each year in America from treatable illness that people in other developed countries don't die from. Rich, middle class, and poor a like. Insured and uninsured. Men, women, children, and babies. This is what being 37th in quality of healthcare means.

I know that many of you are angry and frustrated that REPUBLICANS! In congress are dragging their feet and trying to block TRUE healthcare reform. What republicans want is just a taxpayer bailout of the DISGRACEFUL GREED DRIVEN PRIVATE FOR PROFIT health insurance industry, and the DISGRACEFUL GREED DRIVEN PRIVATE FOR PROFIT healthcare industry. A trillion dollar taxpayer funded private health insurance bailout is all you really get without a robust government-run public option available on day one. Co-OP's ARE NOT A SUBSTITUTE FOR A GOVERNMENT-RUN PUBLIC OPTION. They are a fraud being pushed by the GREED DRIVEN PRIVATE FOR PROFIT health insurance industry that is KILLING YOU!

YOU CANT HAVE AN INSURANCE MANDATE WITHOUT A ROBUST PUBLIC OPTION. MANDATING PRIVATE FOR PROFIT HEALTH INSURANCE AS YOUR ONLY CHOICE WOULD BE A DISASTER AND UNETHICAL, CORRUPT, AND MORALLY REPUGNANT. AND PROBABLY UNCONSTITUTIONAL AS WELL.

These industries have been slaughtering you and your loved ones like cattle for decades for profit. Including members of congress and their families. These REPUBLICANS are FOOLS!

Republicans and their traitorous allies have been trying to make it look like it's President Obama's fault for the delays, and foot dragging. But I think you all know better than that. President Obama inherited one of the worst government catastrophes in American history from these REPUBLICANS! And President Obama has done a brilliant job of turning things around, and working his heart out for all of us.

But Republicans think you are just a bunch of stupid, idiot, cash cows with short memories. Just like they did under the Bush administration when they helped Bush and Cheney rape America and the rest of the World.

But you don't have to put up with that. And this is what you can do. The Republicans below will be up for reelection on November 2, 2010. Just a little over 13 months from now. And many of you will be able to vote early. So pick some names and tell their voters that their representatives (by name) are obstructing TRUE healthcare reform. And are sellouts to the insurance and medical lobbyist.

Ask them to contact their representatives and tell them that they are going to work to throw them out of office on November 2, 2010, if not before by impeachment, or recall elections. Doing this will give you something more to do to make things better in America. And it will help you feel better too.

There are many resources on the internet that can help you find people to call and contact. For example, many social networking sites can be searched by state, city, or University. Be inventive and creative. I can think of many ways to do this. But be nice. These are your neighbors. And most will want to help.

I know there are a few democrats that have been trying to obstruct TRUE healthcare reform too. But the main problem is the Bush Republicans. Removing them is the best thing tactically to do. On the other hand. If you can easily replace a democrat obstructionist with a supportive democrat, DO IT!

You have been AMAZING!!! my people. Don't loose heart. You knew it wasn't going to be easy saving the World. :-)

God Bless You

jacksmith — Working Class

I REST MY CASE (http://krugman.blogs.nytimes.com/2009/07/25/why-markets-cant-cure-healthcare/)

Republican Senators up for re-election in 2010.

* Richard Shelby of Alabama
* Lisa Murkowski of Alaska
* John McCain of Arizona
* Mel Martinez of Florida
* Johnny Isakson of Georgia
* Mike Crapo of Idaho
* Chuck Grassley of Iowa
* Sam Brownback of Kansas
* Jim Bunning of Kentucky
* David Vitter of Louisiana
* Kit Bond of Missouri
* Judd Gregg of New Hampshire
* Richard Burr of North Carolina
* George Voinovich of Ohio
* Tom Coburn of Oklahoma
* Jim DeMint of South Carolina
* John Thune of South Dakota
* Kay Bailey Hutchison of Texas
* Bob Bennett of Utah

[Please don't cut-and-paste like this again. It's extremely difficult to converse via drive-by, and we're at least notionally all about conversing - Ed.]

[Ben Alpers]

the public option needs a 60 Dem Senate in a way that increasing the scope of the exchanges does not.

Are we watching the same Senate? The Senate seems even less likely to produce a bill with a public option than the House is. And the ones standing in the way of a public option are, in the first instance, Democrats, who really do currently hold all the cards.

I'm not saying that Dems should fight to the death on the public option, but it's worth making some very serious noise about, both politically and policy-wise.

Which is, from a game theory perspective, the problem with only sorta kinda insisting on a public option. If Dems don't fight to the death on the public option, they certainly won't attain the political benefits of fighting to the death on a public option.

And once again, this is also a misframing of the debate. The fight over the public option where it is currently taking place -- the House-- is a fight within the Democratic Party. Indeed, the already anemic public option is currently being killed off by the Blue Dogs.

[Point]

Just wanted to pop in and say I essentially agree with this post -- and to thank von again for the http://www.kff.org/healthreform/sidebyside.cfm ">Kaiser website.

Looking at it, I think it would be less accurate to say that the Wyden bill has great ideas that can wait -- though that is true -- and more that both the House and Senate HELP bills make the horrible mistake of restricting access to their health insurance exchanges to those with no access to "decent" employer coverage.

This, like von says, only strengthens the bond between your job and your insurance, and rolling that back in the future may prove trickier.

[publius]

and just for record, i'm 100% with von on liking wyden and wanting to get rid of employer health care structures. but i think the exchanges + Wyden are the best way to phase that in gradually.

We're all about Edmund Burke here at ObWi

[Gary Farber]

"Yeah, that's what's got us frightened: That getting the public option will be rather like contracting cancer: Not so bad at first, but it will grow."

As a point of fact, Brett, the vast majority of the New Deal agencies were rapidly eliminated; several in the middle of the New Deal itself.

Tell me if you currently see any of the following around:
Works Progress Administration
National Recovery Administration
Civilian Conservation Corps
Civil Works Administration
Federal Works Agency
Federal Writers' Project
Federal Emergency Relief Administration
National Youth Administration
Public Works Administration
Federal Theatre Project
Federal Music Project
Defense Homes Corporation

Yes, we still have some leftovers from, and expansions of, the New Deal (and I thank goodness for it, unlike you), but most of it, in fact (and unlike you, I regret a lot of it), went away.

I wish we had a WPA right now.

[Sebastian]

Maybe it is really true that Democrats are just horrific at marketing. Instead of 'public option' they should clearly be talking about Medicare for the unemployed or something like that. Medicare, medicare, medicare. People love it. Why not use the brand name that people love?

Sure it would drive Republicans crazy, but you already think that 100% of them will vote against health care 100% of the time. So move on from them already and tout Medicare for the unemployed to the American people.

It doesn't threaten people who have jobs, and there has probably been no time in the past 50 years where people have been more worried about the jobs they have.

[bitchphd]

Exactly, re. post. Already the idea that people who are employed or can afford private insurance can't choose the public option instead grates (and whatever happened to the R argument for consumer/voter choice, anyway?). But at least if there *is* such an option, one can buy into it during times of unemployment or what have you, and maybe eventually get the option to retain it rather than having to switch with every change of employer or new job....

Because seriously, one of the major problems with the existing system *is* having to switch with every new job (or whenever one's employer switches plans), then learning all over again what is and isn't covered, whether or not one can continue to see the same doc, how you're supposed to handle prescriptions *this* time, etc. One of the huge draws of a public option is consistency.

[Gary Farber]

"[Please don't cut-and-paste like this again. It's extremely difficult to converse via drive-by, and we're at least notionally all about conversing - Ed.]

Posted by: jacksmith | July 30, 2009 at 01:30 PM"

Wait, jacksmith wrote a note to himself? Or did one of the bloggers go into a signed comment and alter it without permission? Or what?

If it's the latter, I really feel very strongly that that absolutely shouldn't be done, well, ever. Either delete a comment, or delete it and ask a commenter to revise and resubmit it, but never change or add something else to something someone else signed. That's completely unprofessional. And if that's what was done, it's not even been signed by which "ed."

On the other hand, maybe jacksmith just published a note to himself as part of his cut-and-paste job?

[Gary Farber]

"Maybe it is really true that Democrats are just horrific at marketing. Instead of 'public option' they should clearly be talking about Medicare for the unemployed or something like that. Medicare, medicare, medicare. People love it. Why not use the brand name that people love?"

They're trying. Obama yesterday:

[...] But in Raleigh and in Bristol, a city he last visited in June 2008 as part of the day-long start of his general-election campaign, he asked the audience to reconsider any belief that the government is incompetent.

"This is not something that is impossible to do, but we've got to overcome the understandable skepticism that somehow Washington can never get anything right," he said in Raleigh.

The answer came in response to a question from Patty Briguglio, who owns a public relations firm and provides health-care benefits to her 20 employees. She asked Obama for evidence of why a new government-run health-care system would be better than the current one. Obama cited Medicare and the Department of Veterans Affairs system, which function differently but, he said, have high satisfaction rates.

Here, Obama addressed a smaller and more frightened audience.

Protesters lined a nearby intersection, and Obama explained their opposition as the result of "misinformation." After several questions, an elderly woman rose to say she worries that "the new system" would force a change in doctors and that "older citizens will just be put out to pasture."

"Say it isn't so," she asked.

Without pause, Obama answered: "It isn't so."

Most people don't follow the news.

Local report:

[...] Obama: "Medicare, which seniors rely on, is going to become more and more vulnerable. On current projections, Medicare will be in the red in less than 10 years."

The record: The trustees of Social Security and Medicare say the insurance program is spending more each year than it takes in. At the current rate of deficit, the trustees predict the Medicare Trust Fund will exhaust its reserves in 2017.

Obama: "Medicare and the VA are both government-run health care programs that have very high satisfaction rates. Generally, if you look at surveys, they have actually very high satisfaction rates."

The record: A national poll conducted by the Kaiser Family Foundation in April found 68 percent of Medicare recipients were satisfied with their health care. Among those with private insurance, the satisfaction rate was 48 percent.

A 2008 poll by the U.S. Department of Veterans Affairs said 79 percent of patients classified their health care services as "excellent" or "very good."

Etc.

[Slartibartfast]

"I really feel very strongly that that absolutely shouldn't be done, well, ever."

I've seen it done a lot on blogs, or at least on the blogs I visit. They might be wrong, too.

"That's completely unprofessional."

I'm pretty sure none of us here at OW are professional bloggers, or even professional editors. All of the ice cream you ever get here is free.

Interpreting your comment as a request, though, we'd have to actually talk it over, because I'm almost positive there's no overt or covert policy regarding that kind of thing. Plus, we hardly ever talk. Maybe this is a good excuse to get together and have a beer.

Each.

It was me, just to be extra clear, that wrote that. But now that you've objected, I realize I should have either left it alone or deleted it, as either would likely have no influence at all on jacksmith's future cut-and-paste attempts.

[Sebastian]

Thank you Gary. But why not call it Medicare? Why ever talk about the public option again? Just say: unemployed people will have the option to use Medicare.

[Marty]

"The record: A national poll conducted by the Kaiser Family Foundation in April found 68 percent of Medicare recipients were satisfied with their health care. Among those with private insurance, the satisfaction rate was 48 percent."

Unfortunately, these numbers don't take into account the expectations of the services from each. I am not satisfied with the healthcare I receive but apply a much higher standard of expectation than I would if I were covered by Medicare.

Just saying, statistics need to be understood.

I also think we should just call it Medicare.

[tgirsch]

But why not call it Medicare? Why ever talk about the public option again? Just say: unemployed people will have the option to use Medicare.

Because it wouldn't be Medicare, at least not exactly. You'd instead have a quasi-Medicare with some alternate funding mechanism. Seniors don't currently pay premiums for Medicare. Are you suggesting that the additional groups you'd be covering under Medicare would ALSO not pay premiums? And if not, how do you pay for it? You've suggested some kind of "sliding EITC type" somethingorother, but I don't pretend to understand what you mean by that.

[Adam A.]

How about this: every time a politician wants to say "public option", he/she replaces it with "a medicare-like public option". By always juxtaposing the two, it makes it clear the basic outlines of what "public option" means while indicating that the two are not totally equivalent.

[Sebastian]

Medicare premiums are in fact common. They have a schedule for it and everything. The premium for 2009 for hospital care is $443 per month. It would of course be lower if we added the uninsured, because they are on average much healthier than the much older population currently served by Medicare.

The premium for what you would think of as basic non-hospital care is $11.25 per month on top of the hospital care premium with a 20% copay.

The EITC type scale is a reference to the Earned Income Tax Credit, which is designed to subsidize the working poor without dis-incentivizing work by having a sliding scale slowly phasing out the subsidy.

[ken]

Sebastion, according to the Medicare website Mecicare premiums are, in fact, mot paid by most people. To say they are common is not accurate.

All you need is 40 quarters (ten years) of Medicare covered employment and you pay no premiums for hospital coverage under Medicare.

The premium you cited is for those without the ten years of employment. Surely that is very small group.

[Sebastian]

"The premium you cited is for those without the ten years of employment. Surely that is very small group."

That depends on how many millions you count as very small I suppose. In any case you can use that premium for the unemployed, subsidized on a sliding EITC-like scale. You can decide how much you think you need to subsidize it when you peg the EITC-like scale.

My point remains that it wouldn't be like Medicare. It would be Medicare. Some people pay the full premium, others paid it in the past through the Medicare withholding from their employer. All Medicare.

[ken]

Sebestian,

I see your point and I agree that we can provide Medicare to those without insurance by using the Medicare premiums as a starting point to determine how much to charge.

Why do politicians always want to complecate things so much no one can understand?

Just extend Medicare to everyone, or extend it down the age bracket to 60 or 55, or extend it to those who want it as an alternative to private insurance.

Everybody understands Medicare. Not many understand what Obama is proposing.

[Gary Farber]

"I've seen it done a lot on blogs, or at least on the blogs I visit. They might be wrong, too."

It's personal opinion. I think such other blogs are wrong. I think people's writings should never be edited without permission, save under completely exceptional (or utterly anodyne) circumstances, and I'd never assume the latter if it's avoidable.

Obviously, it's your blog, and you're absolutely free to set whatever rules or customs you desire.

I'm simply giving my opinion, which is that no professional writer would put up with their words being changed without permission either granted blanket in advance, or dealt with on an individual basis, and it would be considered the sort of offense that results in someone quitting or being fired in many professional circumstances, and I don't think non-professional writers should be granted any less courtesy. In my opinion.

It's certainly true that other bloggers have had different approaches; Brad deLong, I know, used to have the habit of inserting his own responses into the middle of people's comments, and I always found that appalling, despite my general high esteem for Brad, because I consider it an abuse of power. Bloggers already have rights of deletion, rights of reply, rights to reply in front page posts, and rights to do what they want. That doesn't mean they should necessarily just do whatever they want because they can. More obviously, I think, most people would agree that one shouldn't write up a comment from scratch and sign someone else's name to it. I'm simply saying the same principle applies down to the letter, if there's no reason not to apply the same principle, such as, say, a comment having already been posted, and you suddenly realize there's a risk of libel, or compromising a military secret, or a police investigation, or something else as strongly exceptional as that.

People who are not me are free to have entirely different opinions.

"Interpreting your comment as a request, though"

Please do; I certainly didn't mean to imply I meant it as anything else; merely that it's a practice I feel very strongly about, because of my professional background.

When professional writers submit their manuscripts for copyediting, in most circumstances, the copyedited manuscript is sent back to the writer, for approval, with a lot of changes being queries, not direct changes. The writer then has final say/approval over whether something is a "correction" that is reasonable, or a mistake/misinterpretation on the part of the copyeditor. Same when the manuscript then goes through line editing, and the same when it then goes through a proofreader (this is part of what keeps a writer busy, as well as people at publishing houses; each time, the copy goes back to the writer for approval, and then back to the publishing house for the next stage in the process, down to final proofs [to be sure, in practice, this can often end up being under very heavy time pressure, and on occasion a stage winds up skipped, but this typically causes much bad feeling]).

There are certainly cases in the past of editors making changes without approval of the writer, and in most such cases, the writers ended up either quitting writing for that editor, or only not doing so because they felt they had no choice, but bitterly resenting it.

Similarly, if something goes out under your name as a writer, under whatever circumstances of posting or publication, you, the writer whose name is signed to those words, are the one held responsible for the final product; not some nameless behind-the-scenes editor. If there's any chance of confusion that's avoidable, I think it should be avoided.

And vice versa: if something is published or posted, anywhere, and edited or added to or subtracted from, without the writer's permission, I think the changes made should, as a rule, be attributed to some identificable/contactable entity; if not, how and who does the edited person know to contact to express any opinion, if they should have one, about what's been changed about, or added to, their comment without their permission?

(Naturally, many people would have no objection; I don't think that should be an assumption, however, as I think it would be a presumption, and an unnecessary one.)

Lastly, on a blog, I see no reason why a blogger can't, in almost all likely circumstances, either simply respond with a following comment, or temporarily delete the comment and ask permission to have the change made, and then repost the comment. So I don't know any reasons why this shouldn't be done. I may, of course, not be considering some exceptional circumstances.

In a case like this, I'd, if anyone asked my opinion, suggest either:
a) ignoring the cutting and pasting; or:
b) posting a comment following it asking the writer to quit doing that; or:
c) finding an email address for the writer and asking them to quit doing that in future; or:
d) if those aren't viable options and/or don't work, just delete the comment, and leave it up to the writer to write the blog and complain if they like. Naturally, I also believe all blogs, save for highly exceptional circumstances, should have an email point of contact reasonable obvious on the blog. All comments submitted need not be responded to, of course, but people should have the option of offering corrections, etc. ObWi, of course, does this.

None of this has anything to do with "professional" in any sense of anyone being paid, or any sense of dichotomy between types of people of any sort; I simply think these are courtesies that should be extended to every last person who puts fingers to keyboard, or mouth to microphone, or who in any way generates text. I see it purely as a matter of courtesy, and that's what I mean -- perhaps a bit confusingly, out of context -- by "professional" and "unprofessional."

But, as I said, anyone can do what they like on their blog, and certainly need not justify their practices, or explain them, to anyone else. This is all simply my personal opinion in the context of blogging practices in general, and I've simply tried here to explain some of my reasoning behind my opinion.

And for future reference, I don't mean to imply a dichotomy between "professional" and "amateur" as between "paid" and "unpaid," but between what's a -- in my personal opinion -- justified and reputable practice, and what in my opinion is not. I mean absolutely no insult by that, as there's no reason you should have been aware of the reasoning I've just explained. And you're absolutely entitled to disagree with my reasoning, and ignore me. I'm simply explaining how I believe everyone who writes should be treated identically and fairly and transparently in a given context, absent individual arrangements being made otherwise, or contexts being different, and that's all, but you're absolutely free to think I'm wrong.

"How about this: every time a politician wants to say 'public option', he/she replaces it with 'a medicare-like public option'."

That sounds good to me; someone else who knows more about the issues might be able to explain any problems with that, but not me.

[Gary Farber]

"When professional writers submit their manuscripts for copyediting, in most circumstances...."

To be slightly clearer here, I'm referring to professional mass market book publishing: not to newspaper journalism, nor to downmarket magazines, or certain other kinds of professional writing.

[Gary Farber]

And to get into the weeds a bit, I'm not referring to most "work-for-hire."

[John Thullen]

Yeah, let's call it Medicare.

But why does a person need to be unemployed to qualify?

Should we call it Medicare, the opposition Party (what shall we call it?) will attack Medicare, assigning it names we've heard before. When they are done scaring the crap out of everyone with their unAmerican scum lies, instead of expanding Medicare, Medicare will face even more opposition than it does now, placing IT on the ropes.

Meanwhile, legislators in Florida and Texas non-Governor Rick Perry are fashioning laws and initiatives to prevent any sort of new Federal healthcare programs in their states.

President Obama should begin massing troops along the borders of these states. George Wallace is alive and well and it's time to knock on the mansion with a gun in one hand and orders from the President in the other.

[John Thullen]

"rather like contracting cancer" ..........
........from Brett Bellmore up top.

My mother survived breast cancer. She also also receives a Social Security check and Medicare. I'll ask her about the ratherness of these.

Rather, indeed.

The Republican Party is an inoperable, mestastisizing tumor on the body politic's brainstem.

Despite the fact that it's a pre-existing condition, I am willing to cover the radical treatment required (nuclear medicine, radiation, gleaming, whirling scalpels, severing the head at the neck, whatever rather-like treatments do the job), even if it kills the patient, who should have known better than to do whatever he/she did to contract the cancer.

[Slartibartfast]

I'm simply explaining how I believe everyone who writes should be treated identically and fairly and transparently in a given context, absent individual arrangements being made otherwise, or contexts being different, and that's all, but you're absolutely free to think I'm wrong.

Message received, and [mostly] understood, Gary. Thanks for elaborating, and also thanks for not taking my response to you as pissy, which on reread it certainly seemed as if it could be. Wasn't intended that way, though. As an unprofessional writer, it's hard to anticipate what sorts of things would cause anguish to folks who have written for a living for years, and are familiar with the rules of behavior that go along with that trade.

It seems as if option a) would have been the best choice in this instance. For seriously long C&Ps, though, outright deletion might be the best policy, which is more or less equivalent to your option d), as for the most part if you (as I did) Google and find this exact same C&P in dozens of other comments, the author wasn't interested in conversation in the first place.

One of these days we'll have to have a summit, complete with alcohol and drug abuse, lots of profanity, and objectification of any and all sexes. Oh, and we'd probably have to get around to discussion of some ground rules for handling comments.

Again, thanks, and thanks.

[Slartibartfast]

First paragraph ought to have been in quotes. I could claim Typepad ate my HTML, but in reality I just forgot and hit post too soon.

[hf]

I am saying the Dems should fight to the death for a public option. Because I believe the private health insurance companies do not want to pay for treatment where it counts, and I don't think they'll do it unless they fear competition from a public option in the future. I don't care what the esteemed Senators from the insurance industry say on this point.

Also, Shouty McCutnPaste got this much right: universal health coverage without a public option means giving money to the insurance companies, which people will rightly see as another bailout to wealthy people who failed at their jobs. And if we accept my first point, this will destroy the Democratic Party for at least a generation.