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Speaker Pelosi Throws Down The Gauntlet For The Public Option--Will She Succeed?

Brian Beutler | October 21, 2009, 1:17PM

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HCAN, Harry Reid, Health Care, House of Representatives, Nancy Pelosi, Public Option, Senate, White House

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There are no two ways about it. What Speaker Nancy Pelosi's doing in the House of Representatives is a big play, and very, very bold--indicative of her confidence in both the wisdom of the public option as a political and policy tool, and
in her ability to get results out of her 256 member caucus, despite the wide ideological chasm between its most liberal and most conservative members.

Pelosi's pulling out all the stops to pass a health care reform bill with a public option that pays providers at rates slightly higher than Medicare--even if it means she has to squeak a bill out of the House with the barest majority. Since the beginning of the push to pass reform, the public option has been at the center of the fight, pitting Republicans, moderates, and major industry stakeholders against an extremely determined majority of Democrats, progressive interest groups, and the public at large. It has been an epic tug of war, and at times, the pro-public option side seemed on the verge of being yanked into the mud.

But in recent weeks, as the health insurance industry further disgraced itself by rolling out the big anti-reform guns, and liberal leaders in both the House and Senate made it clear that they view the public option as an essential component of reform--one that serves voters' interests, and saves money--even if the White House isn't willing to put its full weight behind the measure.

It's in that context that Pelosi is running thiis public option endgame.

At last count, she's still eight votes shy of the crucial 218 she needs to pass a robust public option plan, though key players seem to think she has momentum on her side. If she can't whip up those last eight votes she'll likely have to revert and move ahead with a more modest public option--one that negotiates rather than dictates reimbursement rates. That would disappoint reformers and progressives in her caucus. But she (and they) will be able to say she pulled out all the stops.

All of this is at the heart of what she's trying to accomplish more broadly. She's staking out the boldest, most progressive ground she can to give key provisions, like the public option, strong odds when it comes time to negotiate away the differences between the House bill and what will almost surely be a weaker Senate version.

And she's laying down a mark she hopes the Senate will follow, saying implicitly that the chamber that represents all voters equally supports a bold public option, and daring skeptics to do the bidding of the unpopular minority. That could put public option skeptics on the Democratic side of the Senate in an awkward position. (Just yesterday, one of the Senate's most conservative Democrats seemed to indicate that a public option might not be so bad, so long as states have the option of pulling out of the plan if they so choose.)

All of this comes with some risk, however small, that the strategy blows up in her face--either that she can't scrape together the minimum votes needed to pass a robust public option now, or that she can, but in a way that unites skeptics, who may feel strong-armed and refuse to play nice in negotiations. By and large, it seems she'll have the vast majority of the Democratic base, including its well armed pressure groups, on her side. And she, more than perhaps anybody in Washington, knows how to pass the bills she wants passed. Stay tuned.