Look to Howard Dean for cues and clues to the fate of health reform. The former Vermont governor, presidential candidate and Democratic Party chairman was
that real health reform had to include a government-run public plan. He's now supportive of a Senate compromise that's a long way from where we started, but possibly the only way to get us to the finish line.
Dean, a medical doctor who achieved near universal coverage of Vermont children when he was governor, has been talking for years about opening up Medicare to people who are younger than 65. He discussed the idea a few weeks ago with Senate Majority Leader Harry Reid and has been in touch with other senators in the thick of negotiations.
The government's tax-supported Medicare program covers elderly and disabled Americans by reimbursing their doctors, hospitals and other service providers. The Senate may let some people buy coverage at age 55. "This is still real reform," Dean said Wednesday on CBS. He further said, twice, that the Medicare expansion makes more sense than "reinventing another bureaucracy."
You could argue that another part of the Senate proposal -- a national, private non-profit plan run by the federal Office of Personnel Management -- is a similar way of breaking the public option impasse. Once again, the government wouldn't have to create a new entity. If you think about it, that is kind of like a public option, right? Just without the public plan. Or, as MSNBC called it during a Keith Olbermann rant Wednesday night, "Public Optional."
OPM already runs the Federal Employee Health Benefits Plan,
an Internet-based exchange or marketplace where private plans compete for business. It gets good reviews, so maybe OPM can make the market work, Dean told The Huffington Post
. He did not seem particularly downhearted at the apparent death of the public option he once insisted upon.
Nor did President Obama. He said the "creative new framework" dreamed up by the Senate constitutes "critical progress" toward passage. Chris Bowers at OpenLeft.com went so far as to argue that the compromise represents a victory
for public option advocates.
But the quick shifts and myriad missing details are creating confusion and divisions on the left. Jane Hamsher at Firedoglake.com called the Senate framework "a pig in a poke
." Markos Moulitsas at Daily Kos blasted an "obstructionist gang"
and said his party could be in for "a world of hurt" in next year's elections. Public option fervor rages unabated on the homepages of MoveOn.org
and of Democracy For America
, the 1 million member political organization Dean founded.
One DFA petition, headlined "Democratic Caucus Accountability," threatens revenge against public option foes. "If ANY member of the Democratic Caucus joins a Republican filibuster of healthcare reform with a public option, the Caucus must immediately strip that Senator of all Committee Chairmanships," it says.
Dean himself wrote at Daily Kos, under the headline "We Can Do Both
," that a public option is essential for consumer choice. But he again praised elements of the Senate compromise and said whatever is signed into law will not be the last word on reform. "While we may be able to take big steps in the right direction -- the fight for health care reform does not end here," Dean wrote.
DFA chairman Jim Dean told me that Howard, his brother, is "just trying to move this ball forward one step at a time. He hasn't really passed judgment on the entire package because nobody knows what it is yet." As for DFA, Jim Dean said, "We know that there's a House bill that has a public option in it and we're going to keep fighting for it."
There are plenty of liberal House members who feel that way, too. But they should ask themselves some questions. How long do they want to continue to debate health care at the expense of other issues -- like jobs? How much holiday family time do they want to sacrifice? After watching the Senate struggle for 11 months, do they really think House and Senate negotiators could come up with a public option acceptable to 60 senators?
No one was more excited about a public option than I was, but the votes just aren't there. It's time for liberals to accept reality. Howard Dean looks like he's started down that road.