I've been fighting all year for a strong public option to compete with the insurance industry and bring health care spending down. I continued that fight during recent negotiations, and I refused to sign onto a deal to drop the public option from the Senate bill. Unfortunately, the lack of support from the administration made keeping the public option in the bill an uphill struggle.Note that Feingold does not say that the White House "killed" the public option; he just says their lack of support was unhelpful.
As I've argued here before, I think the defeat of the public option was a fairly robust outcome. That is, I don't think that if you went back in time and made relatively minor, random changes to the parameters the Senate was facing, you'd have wound up with a public option in the bill very often.
The role of Joe Lieberman, for instance, may be somewhat overstated. He may have killed the Medicare buy-in -- but not the public option per se, where there were at least 3-4 strong nos. Nor is it clear that the Medicare buy-in had ever secured 59 votes for passage. Ben Nelson, for instance, was a problem there, as might have been a handful of other Democrats.
And in so far as the more robust versions of the public option went, the Senate was never particularly close. The robust, Rockefeller-type public option failed 8-15 in the Senate Finance Committee and did not have the votes in the House; the semi-robust Schumer-type public option failed 10-13 in the Finance Committee and barely passed the House.
But what about more major changes to the the landscape the Senate was facing? As I argued back in June, I think it would have behooved the White House to take a more publicly and manifestly "hands-on" approach with the health care bill. The political lesson of the stimulus was that outsourcing the salesmanship of key legislation to the Congress, a highly unpopular institution, is likely to result in both less liberal and less popular policy than if the legislation is championed by the White House -- which was a highly popular institution at the time the health care debate began.
The White House, indeed, may have overlearned the lessons of the Clintons, whom conventional wisdom holds took too obstinate a position with the Congress. Or, they might have overestimated the extent which they could "quarantine" the legislation in the Congress. Suppose that the White House anticipated that the health care legislation was going to become somewhat unpopular. OK, so you dump it on the Congress, and let Nancy Pelosi and Harry Reid take the hit, while Obama remains above the fray. The problem with this is that Obama can't remain completely out of the way, and the more you put Congress in charge, the less popular the legislation will have become when you do encounter it again. (Sorry for the crude metaphor, but it's a bit like a sexually transmitted disease that you pass on to a one-night stand, only to catch it again in a new, more virulent form when you sleep with the same person some months later.) In other words, by not willing to spend enough political capital on health care legislation, Obama may in the end have cost himself more political capital, because the negotiating process was dragged out and the final product made less popular.
There are others who would say that this was just the way it was going to have to be -- Congress is the more powerful institution than the Executive by some margin, and it gets pretty territorial, particularly when it comes to legislation as important and complex as health care. And the White House did, after all, end up with a good result -- it appears as though it will get a pretty good health care bill passed, something no Administration has done before.
This counter-argument is perfectly reasonable. But complex processes like this can oftentimes be fairly path dependent, and a White House that had been even marginally more proactive early in the process could have made some difference. I don't think the White House could have done very much, on the other hand, to "save" the public option late in the process.
Of course, we're talking mostly about about how the White House sold -- or failed to sell -- the health care legislation to the public, and not necessarily the substance of the policy. Still, part of the public consists of liberals, and it was clear very early on that the public option was a particular fixation of certain liberals and progressives. If the White House was not willing to put a lot of political capital behind the public option, if it had calculated early on that the defeat of the public option was inevitable, it seems to me that it could nevertheless have done a better job of preparing liberals for the defeat, or selling them on the other virtues of the health care bill. Instead, there was a bit too much reliance on trial balloons and backchannel communication, a poor fit for a perceptive progressive blogosphere that seeks greater honesty, openness and transparency.