Who Really Killed the Public Option?

A Look Back at the Losing Strategy that Keeps Hurting Democrats

In late 2009, despite their filibuster-proof majority of 60 seats in the Senate and popular new President, Democrats could not manage to hold their party together long enough to include a public insurance option as part of the Affordable Care Act. NPR’s David Welna, expressing his incredulity at the time, wrote that while “Most polls show that a majority of Americans want a health care overhaul to include a public option…it might seem logical that Senate Democrats, with their 60-vote majority, would include a public option in the bill.” Yet, defying all logic, the Obama administration and the party leadership abandoned the effort after encountering resistance from Democrats in the Senate Finance Committee.

Their argument, accepted by other Democrats and implicitly by the President, was they feared the vote would cost them reelection. And with that, one of the most popular policies in the country was dismissed, and for the next several years Democrats have struggled to market that massive missed opportunity as a resounding success.

There are a number of explanations for a lack of party discipline in the modern era: a broadly weakened party structure, new campaign funding methods, the rise of interest groups, and reduced competition in increasingly gerrymandered districts. There is little dispute that each of these factors contribute, however all of these structural underpinnings apply pretty equally across both parties. Yet, in spite of this, Democrats have shown themselves uniquely inept at maintaining party discipline in support of achieving widely popular policy goals.

Some of this is self-inflicted, like repeatedly helping elect Joe Lieberman who would caucus with Democrats and subsequently vote against them. Democrats like Senator Feinstein of California campaigned for Lieberman — even when he formally left the party — fully aware that his election would weaken the Democrats and undermine her own vote in the future. It’s no wonder individual members are not afraid of bucking the party without fear of consequence — all the interest groups have to do is lean on a handful of representatives — and those representative are fully aware that the party will forgive them long before the interest group.

But the public should not forget. Just last week, Corey Booker, who even as he was earning accolades from the public for testifying against the confirmation of Jeff Sessions as the head of DOJ, quietly voted with Republicans to kill the Sanders/Klobuchar amendment hoping to make affordable Canadian pharmaceuticals accessible to Americans. Not surprisingly, Booker is the single highest recipient of pharmaceutical lobby money over the last 6 years of any Senator. While the incoming Trump administration prepares its long promised repeal of Obamacare, progressives must continue to “out” corporate Democrats like Booker who have for too long relied on savvy public relations to highlight their rhetorical attacks on racial injustice only to stand firmly in defense of the financiers of economic oppression — whose very actions disproportionately hurt the underrepresented communities Booker claims to defend.

You Shall not Pass

It is worth recalling that the House of Representatives version of the Healthcare Act included a public, non-profit alternative to private insurance. The plan was killed in the Senate, not by Republicans whose support it never had, but by a handful of Democrats on the Senate Finance Committee— Max Baucus of Montana, Kent Conrad of North Dakota, and Blanche Lincoln of Arkansas.

Like Booker, these Democrats voted with the Republicans to gut policies that would make meaningful improvements to the actual affordability of healthcare. The glib attitude most political analysts use to gloss over this dismissal of democracy is that, acting on instincts of self-preservation, these representatives feared support for such a liberal bill would jeopardize their reelection bids in conservative districts.

Yet, Baucus, who had just been elected Senator for the sixth time in 2008, was almost a full term from reelection, and ultimately decided to retire instead of running again in 2014. So much for that. He also happened to be a major recipient of healthcare and pharmaceutical industry contributions. He resigned from the Senate, having been appointed by President Obama as US Ambassador to China before the end of his term. An odd sort of intra-party punishment for someone responsible for undermining the President’s signature achievement. John Walsh, appointed to fill the open seat, dropped out only months later on the news that he had plagiarized his Master’s research at the Army War College, resulting in the election of a Republican.

Kent Conrad of North Dakota, up for reelection in 2012, also decided to retire rather than run again for reelection, presumably to focus on obstructing popular policies at home. Blanche, the third crucial vote, who at one point proclaimed she would filibuster the bill if it included a public option, ultimately lost her reelection effort in 2010 by a whopping 21% — a margin far beyond that which the ACA could have caused even in the most conservative districts. This was the end of the public option and the beginning of a precipitous drop in support for the healthcare bill. Baucus, who later regretted his decision to vote against a public insurer, argued at the time he would not support it because he feared the bill would not reach a filibuster-proof 60 votes in the Senate. Rather than exert any real effort into compelling these Democrats to vote in favor of the public option, the Senate leadership caved to this small minority.

In short, Democrats abandoned a public option — not because the public rejected it, but for fear of the health care lobby fight and Republican opposition that would ensue. In order to prevent a political conflict over substantive issues, Democrats’ fear of losing kept them from any spirited defense of a public insurer. This argument begs the question elected officials are loathe to discuss: If the public option was the most popular, why would voting for it end one’s career?

Lets be clear about something: this is not representation, it is obstruction.

Give it to me Straight, Doc

Despite the notable improvements of Obamacare, the US healthcare system still lags considerably behind other advanced economies. A study from the American Journal of Medicine revealed that in 2007, before the Affordable Care Act, 62.1% of all individual bankruptcies filed that year were the result of medical expenses. While the ACA seems to have reduced that burden somewhat, medical expenses continue to be a leading cause of financial hardship. And while advocates of privately funded healthcare bleat on about the innovations of a free-market system, the medical outcomes in the United States illustrate a starkly different picture.

Despite the empty rhetoric that the cost of US healthcare reflects its quality, the third biggest killer of Americans is medical/hospital error, perhaps even more. On top of that, we spend more than any other country on healthcare and yet our infant mortality rate is higher than most democracies, but also Cuba, Latvia and Belarus. And despite the hysterics of rationing care and death panels under a public insurance provider, the real systemic problems in American healthcare are more likely highly profitable over-treatment, evidenced by the fact that we are the most heavily medicated society on the planet while resulting in poorer outcomes, exemplified most gruesomely in the profitable enterprise of rising prescription opioid deaths. Still, despite these alarming realities, the American Medical Association’s mission “to promote the art and science of medicine and the betterment of public health” came second to protecting profits for medical providers in their powerful opposition to a public option.

Recent polling shows that nearly 60% of Americans prefer a single payer medicare-for-all system, and more surprising — as recently as the late 1980’s, 40% believed healthcare was a right listed in the US Constitution (it is not). Yet, Democrats — who supposedly represent the interests of the poor and working class — chose a nominee who, while accepting $13 million from the healthcare industry, stated that single payer “will never, ever come to pass.” As Noam Chomsky put it, “There should be headlines explaining why, for decades, what’s been called politically impossible is what most of the public has wanted.”

Pyrrhic Victories

President Obama on Realtime with Bill Maher 11.4.2016

When asked recently about the ACA by comedian and political talk show host Bill Maher, the president came close to acknowledging this contradiction. “If I were designing a system from scratch,” he admitted, “I would have probably looked at a single payer system;” but, he went on, “you’ve got a one-trillion dollar healthcare industry…and a lot of special interests involved.” While the President now suggest the ACA is more of a “starter home” that needs improvements, his own aloof support for the public option during Congressional negotiations was a major point of contention among progressive groups. While President Obama claims he supported a public option, “he has not always insisted on it, and the administration has sent mixed signals about how important it is.” After months of deadlock, when the White House finally introduced its own proposal in 2010, the lack of a public option spoke volumes — undermining its Democratic advocates and emboldening Republican obstruction.

Yet, five years later, during the Democratic primaries when Bernie Sanders was gaining traction, the president seemed to have a change of heart. Writing in the Journal of the American Medical Association, Obama argued that “Some parts of the country have struggled with limited insurance market competition,” acknowledging the obvious and long foreseen failures of the ACA, and offering the solution that “Adding a public plan in such areas would strengthen the marketplace approach, giving consumers more affordable options while also creating savings for the federal government.” The soon to be former-President seemed to be making an anachronistic appeal to a public that had already been demanding a public option for decades — but we would all have been better served had he tried harder to convince himself and three crucial Senate Democrats in 2009.

Fearing retribution at the ballot box, Democrats ultimately sabotaged their own bill, ensuring the very electoral retribution they were guarding against. It almost reads like a Greek tragic-comedy.

With the unexpected election of Trump to the White House, Democrat minority status in both houses, the loss of dozens of state governorships and over 900 state legislative seats over the last decade, the strategy of dismissing popular policies to satisfy Republicans has proven to be a resounding failure.

If a public option had been introduced and passed, the polling evidence suggest fewer Democrats would have lost their seats in 2010, not more. Some of the clearest evidence for this is the fact that of the 34 House Democrats who voted against the ACA hoping to keep their seats — only three remain (John Barrow lost his seat later in 2014). In other words, voting against the ACA was a qualitatively insignificant strategy for winning reelection and maintaining Democratic control of the House. Any seats lost in 2010 could have even been better recouped by campaigning on the success of the Healthcare Act with a popular public option — instead of the widely reported news that nearly a thousand counties will be down to a single insurer in 2017 — a complete failure of market competition, leading to premium hikes as high as 35% in some, predominantly rural areas. This was the sort of issue the ACA was meant to fix. It’s not like Democrats tried and failed — they scrapped it altogether in an effort to court Republican votes while hoping to keep their seats through reelection — and failed at both. The ineptitude of this strategy cannot be overstated, nor can its effect.

For decades now Democrats have sold conservative economics through socially liberal rhetoric. Business interests and contributors who got direct face time forgave the rhetoric so long as they got the policies they wanted. The electorate swallowed the rhetoric assuming equitable economic policies would be sure to follow. For 35 years, they have not; and for Democrats the electoral strategy of placating Republicans by curtailing the public good has finally reached its breaking point.