There was a time only a few months ago when it looked like health care reform could actually be easy. Obama's approval rating was sky high. Baucus and Kennedy had gotten all the different industries to the table. A small but noticeable number of Republican senators claimed to be open to reform. Everyone thought the reform train was rolling out, so no one wanted to be left at the station.
Not so long after those first heady months, everything started to unravel. Obama's approval rating started dropping. The Republican meme that killing reform would kill Obama slowly became party doctrine. Baucus and Grassley failed time after time to make their own deadlines. And probably most devastating, the CBO score came back, and it was bad.
It seemed at first there was hope reform could be a big win-win. Doctors gave a little, Phrma gave a little, insurance companies gave a little and there would be enough to pay to get everyone insured. It seems they were hoping several relatively painless changes like more preventative care, payment structure changes, competitive bidding, electronic records, etc. would have their powers combine into huge savings.
If that first CBO report of health care reform came back at only $500 billion it might all have worked. The medical industries would accept some reforms in exchange for a massive new customer base. Liberals would be forced to give up on the public option in exchange for extremely generous subsidies to the poor and middle class. The bill could have been paid for all through savings or only minor, indirect taxes. A decent bipartisan reform bill would have been quickly passed over some progressive objections.
When CBO director Elmendorf refused to score most of the potential savings the grand coalition fell apart. The knives came out and someone (if not everyone) was going to be the loser. What industries would take a huge hit to their profits? Would liberals be forced to accept very small subsides and getting everyone only bad technical insurance? Would Republicans swallow large tax increases?
When reform went from deal making to knife fighting, Obama lost all hope of easy bipartisan reform. His only hope is to rally his base for an arm twisting partisan bill. The only thing which can rally the base is the public option.
The health care activists tend to be the people who were screwed over by insurance companies or had loved ones that were. They aren't going to waste their weekends knocking on doors campaigning to give insurance companies huge checks from the government. They don't want to see the industry be forced to accept some sensible new regulations. They want to be free of them. They want to see these evil companies dismantled.
Some in the media wonder why Obama's progressive volunteers are not turning out in force for health care reform. The answer is simple. He has made it clear he is not committed to their main goal: freedom from the evil insurance companies.
Progressive activists will not rally around slogans like:
“Several new common sense regulations that end some of health insurance's worst practices in exchange for forcing everyone by law to pay thousands for their product.” or “Demand subsidy levels be 9% instead of 11% of income for families making over 300% of the FPL.”
If Obama wants to get the grassroots fighting with him for health care reform he needs to make a firm promise that he is not going to sell them out. Every time he makes a wishy washy statement about the public option, says everything must be on the table, and claims private cooperatives might be just as good, it is a blow to the grassroots' moral. It is Obama telling them he does not need them, does not want them, and will not stand with them.
If Obama wants to rally an army of activists to his cause all he needs to do is publicly say, “I will veto any bill without a real public option.”