The Politics of The Public Option


Few pieces of policy have had as many congressional lives as the public option. Back during the nascent days of the bill, the public option drew the kind of animus or support normally reserved for the centerpiece of legislation, even though the CBO said that the option as it was constituted would do little to actually control costs.

After the promise of its removal was traded for the votes necessary to secure passage of the bill, it looked like that was the death knell of the public option, but in the last week the possibility of reconciliation has preceded its recent resurgence from the grave.

There is nothing truly preventing its passage at the moment (even though the bill might be easier to pass in the House without a public option). The question is whether Democrats would want to expend even more political capital when the fate of the bill is still fragile and might not be able to withstand the bickering and attention that is sure to ensue over a relatively small and undeserved component of the larger package.

The one caveat is that support for the public option remains relatively high, falling anywhere between 50-55% nationwide. A CNN/Opinion Research poll from January 8-10 found that 54% of people support it, while it was 50% in a February 17-18 Newsweek poll. A recent Research 2000 poll found that in all the states where data was gathered, the public was more supportive of legislation that included the public option but without Republican votes than no public option with Republican votes, even though the bill itself is still unpopular.

This last part needs an explanation, of course, because according to the prior Newsweek poll, almost all of the individual elements of the bill are popular by themselves. There are only two exceptions. One is the fine levied against citizens who do not purchase insurance, even though 59% support the individual mandate, which only works when it is universal and binding. Otherwise people can enter and leave the pool at will, which would ultimately do more damage than good. In fact, the mandate/fine has already been instituted in Massachusetts. Most of the cost of the bill over the next ten years goes toward subsidies, which will help the uninsured pay for the insurance that they would then be mandated to carry.

The second unpopular element is the excise tax, which is only supported by 34% of respondents, but you cannot have a deficit neutral bill and billions of dollars in subsidies without a revenue stream.

Kaiser Family Foundation also did a similar poll.

Of course, the cornerstone of reporting tends to be politics, not policy, and it is doubtful that the public has a clear understanding of health care reform. Nate Silver disparages public awareness of certain elements of the bill and blames much of it on the specter of misinformation. He points to an NBC poll in which support for the bill increased once people learned what was in it.

But if that is true, then why does the public option still receive such relatively high support? Its existence has been torn down and denigrated in the public square, having endured the fracas and clamors of “government takeover”.

One theory to which the paucity of support for the bill could possibly owe its existence is the congressional bartering and dealing endemic to a fractious and elongated legislative process. In other words, the public reasons that bills that face obstruction must deserve it. But the public option faced even greater obstruction and eventually had to be scrapped in order to garner the votes to pass the Senate. If people built opinions on “survival of the fittest”, then support would have fallen to the wayside along with the public option.

Perhaps the sagging poll numbers reflect public anxiety over an incredibly complex piece of legislation with a lot of moving parts, in which understanding is seemingly intransigent, while the public option is simple and easy to understand. Compromises like the Nelson deal sour public opinion, even if the Nelson deal in particular is eventually retracted, but the public option is a purer element that can only be compromised away, which itself might have been an unpopular act. There was even a large push back against Lieberman for his role in getting the public option dropped from the bill.

There is a good chance that the bill itself, once it has moved beyond the legislative process, can be sold as a positive, especially when its benefits slowly begin to come online. But if the public option remains relatively popular, there might be some wisdom in the theory that its passage along with the bill could make the entire package more popular. The other components of the bill can be sold as a compliment to the public option, even if its effect proves to be small. It is difficult to tell without more information. Would the inclusion of the public option be seen as a partisan move, or would it represent a bold move, and would it re-energize a languorous Democrat base?

This depends on the likelihood that the public option is reinserted. It is not likely, even with a growing list of supporters in the Senate. But until the entire package is signed into law, there is always the chance that it could gain another life.