Memo to the Left: The Public Health Insurance Option Is Dead, Get Over It

As the climactic votes approach this week on health care, some groups on the left seem more interested in throwing a wrench into the process than putting a landmark law on the books.

MoveOn.org is in the latter camp. It is asking its 5 million members to back primary challengers to Democrats who don't support the reform package, and at least one union is sending similar signals. MoveOn also is running an ad featuring Presidents Abraham Lincoln, Franklin Roosevelt, Lyndon Johnson and the Rev. Dr. Martin Luther King Jr. "Which side of history will you be on?" it asks. The spot starts Tuesday on national cable, with a six-figure buy behind it, and will run until the House votes on a final package at week's end. The goal is to nudge wavering Democrats into the yes column.

The Progressive Change Campaign Committee and Democracy for America are applying a different kind of pressure. They're crusading until the last possible moment to revive a government-run insurance plan, or public option. Though Speaker Nancy Pelosi and others say a public option could not win the needed 51 votes to pass the Senate, these groups insist she is wrong. That is the premise of this ad expected to start Wednesday on national cable and in Pelosi's San Francisco district -- two or three days before the House takes its final action in a 15-month process.

"This is not helpful," a Democratic aide on Capitol Hill told me, exercising a restraint rarely encountered in the health debate. Let me be a bit more blunt: It's futile, distracting and possibly ruinous at a time when Democrats need every ounce of party energy focused on passing the bill.

This is, finally, the endgame. If you really care about achieving health reform and improving Democratic prospects in November, why would you spend time and money on a cause that could derail the whole project? "Our goal is to pass a good bill, the best bill possible," Progressive Change co-founder Adam Green told me. "We are trying desperately to save Democrats from themselves and turn this bill from a political loser into a political winner."

The public option was included in the health bill passed by the House. It could not get the 60 votes needed to become part of the Senate bill, which is the basis for a final package negotiated by the House, the Senate and President Obama. Liberals say there is a window of opportunity now that the Senate has decided to amend its bill using reconciliation, a process that requires 51 votes as opposed to a 60-vote supermajority. "The Senate has 51 votes for a public option and we can prove it," Democracy for America wrote Monday in an e-mail to members.

Progressive Change breaks it down this way on a Web site called Whip Congress for a Public Option: "24 have signed a letter to Harry Reid asking for a public option in reconciliation. 19 have given statements to us, reporters or their constituents. 4 more have made statements on video. And 4 are extremely likely based on their previous support for the public option and Senate leadership." The groups' new commercial concludes: "The Senate has the votes. The public option is in Pelosi's hands."

But old YouTube videos and vague statements, some from before the bruising debate unfolded, do not constitute a definitive Senate vote count. The idea that a public option has majority support in the Senate is mythical, according to Pelosi and other Democrats. It's also tactically naïve or blind. First, a public option could complicate passage in the House. Pelosi is trying to balance potential loss of support from anti-abortion Democrats against gains that may come from moderate "Blue Dog" Democrats who prefer the Senate bill. They like it in part because it has no public option.

Second, although majorities support a public option in polls, it is unclear how it would actually play in elections. Democrats already are fighting off Republican claims that they are socialists trying to stage a government takeover of health care. That charge would be harder to refute, at least from a PR standpoint, if a public option were in the mix.

Third, assuming a package clears the House, it will be one that has been worked out by House Democrats, Senate Democrats and Obama. Any amendments would start the bill ping-ponging between the chambers until final agreement is reached. And that process could implode at any time – which is why Sen. Dick Durbin of Illinois has said he'll tell Democratic senators to oppose all amendments. We can't risk it, said Durbin, the No. 2 Democrat in the Senate and a public option supporter. For that, Progressive Change treated him to an e-mail blast headlined "Durbin Betrayal."

MoveOn has aligned itself with Democratic leaders in the final days of the fight. In a vote last week, 83 percent of its members said MoveOn should support the final health care bill "if it looks like the plan recently proposed by President Obama" (that is, the Senate bill with fixes reflecting House and White House concerns). "Since then we are taking all that member energy and using it to push forward the momentum to getting health care passed," said Ilyse Hogue, the group's director of political advocacy and communications.

Members still believe a public option is the best way to control insurance costs and spur competition, she told me, and won't let the idea die. "They've fought very hard for progressive positions, including a public option," Hogue said. "They will continue to fight for them after this bill is passed."

That's good old practical politics: Take what you can get and try for the rest later. There will be plenty of time in future months and years for drives to set up a public option or let people buy Medicare coverage. Right now there's a chance to make enormous strides toward universal coverage and set in motion steps to control soaring costs. Democrats who are relitigating settled issues at best are getting in the way and at worst are jeopardizing the future of their party.