A Healthy Debate

With compromises, health-care reform moves forward

Last month, a little more than 100 miles northeast of Knoxville, President Obama stood before aisles of canned goods, deli meats, and strategically-placed advertisements, and in a loose accent converted a Kroger on the Virginia side of Bristol into a town-hall meeting.

"This is the first time I've been in a grocery store in a while," Obama joked in his characteristically dry, isn't-my-life-weird way. "They don't let me do my own shopping!"

These town-hall meetings have by now become notorious thanks to a few unhinged, angry protesters covered ad nauseam by cable news outlets, who together have proved that digesting misleading information is actually worse than consuming none at all.

But as the dust begins to settle and Congress returns from recess to hammer out legislation, Obama has signaled he's open to negotiating on what had heretofore seemed an essential ingredient of his idea of health-care reform: a government insurance plan, or public option, as it's come to be called.

"The public option, whether we have it or we don't have it, is not the entirety of health-care reform," Obama said in another town-hall meeting, this one in Grand Junction, Colo. "This is just one sliver of it. One aspect of it."

The public option has been controversial from its inception, proposed as a way to increase competition, drive down costs, and provide coverage to many of the 47 million Americans without it. In some ways it's akin to how TVA was originally envisioned, as one of Franklin D. Roosevelt's "yardsticks to prevent extortion against the public," an idea that yielded mixed results.

Yet conservatives, insurance companies, and many small government types claimed the cost of a public plan would be too great and the government's role in the private market too large, and so they mobilized bodies against it. In substance, they are right to raise these concerns at a time when the deficit is ballooning and health care already consumes one of out of every five dollars.

But their style is another thing and proves that either they don't believe their own arguments or believe them to be too abstract to be politically expedient. As a result, they've resorted to the timeless tradition of lying in order to scare people into opposing something they clearly don't understand, and thus the references in town halls to Nazis, "death panels," and socialism. (In Family Feud, the category would be "Thing we don't like.")

So did it work? Did fear mongering and manipulation win the day?

Well, recently Senate Democrats announced they would remove a provision from their bill that would have funded a consultation with a doctor for Medicare patients every five years on end-of-life care, conceding to pressure raised by Sarah Palin and others who cynically misconstrued these consultations as "death panels."

This is an unsurprising move by Palin, whose limited knowledge and experience preclude her from engaging the merits of an argument. But the visceral rejection to discuss end-of-life care is ideologically inconsistent coming from social conservatives, who typically pride themselves on their sanguine outlook on facing death.

Secondly, Obama clearly is hedging his bets on a public option, even though back in Bristol he was again in favor of it, saying "I still think the notion of having a public option that people can sign up for voluntarily is something that needs to be part of overall health care reform."

This ambiguity in the president's position reflects less the noise of recent weeks and more divisions within his own party and between houses of Congress. Liberal Democrats in the House say they won't pass a bill without a public option, while more moderate ("Blue Dog") Democrats in the House and Senate look unlikely to pass a bill that includes such a provision. Republican ranks are too depleted to matter, but embedded in removing them from power was adopting more conservative representatives into the Democratic fold that now threaten the liberals' agenda.

All of which is to say this is politics, the process by which disparate groups compete for various goals. In that process some things are traded away, some things are gained, and everyone goes home feeling like a loser (or winner, depending on your outlook in life).

If there's no public option, it's not the end of liberalism, it's not Obama's Waterloo, it's just another political compromise on an issue extremely important in both personal and national terms. The reform bills being considered would still provide a host of protections for consumers seeking coverage as well as subsidize many low and middle-income families, going far to remedy many problems.

And if the eventual law helps control cost, extend coverage, and increase competition, then the country will have taken a great step forward under Obama.

One could be forgiven for forgetting the forest for the trees. Between contemptuous conservatives who claim to love this country so much yet show such little respect for its elected officials and democratic institutions, and contemptuous liberals who dismiss as a corporate shill anyone who doesn't wholeheartedly agree with their position, it's sometimes hard to maintain one's bearings.

But it's also a good sign. That each party's margins are enraged probably means some necessary reconciliation is happening.

After years of tailoring facts to suite ideologies, the country elected a pragmatist as president. This is what pragmatists do.