The fundamentals of the public option are, in some sense, still fairly strong. It polls well. Perhaps more importantly, the CBO seems to think that it would save money. For this reason, I don't think we can completely rule out the possibility that Lincoln, Nelson, et. al. could be persuaded about its merits. Also, importantly, the bill that will be reported to the Senate floor will contain a public option, which leaves it with a certain amount of inertial momentum.
But I do think it's going to have to be a matter of persuasion -- and not strong-arm tactics. The two strong-arm tactics that people seem to be excited about are reconciliation -- a procedural maneuver to pass the bill through a majority-rules environment -- and a "progressive block" strategy in which progressives threaten to vote down the health care bill unless a reasonable public option is included. I don't think either of these are liable to have their desired effect.
What's wrong with the progressive block strategy? For one thing, it's not clear that the threat is credible. Technically speaking, the bill that the House passed did not contain what had initially been defined as a "robust" public option -- meaning one pegged to Medicare rates. But only one or two progressives wound up voting against it for this reason, even though many had threatened to do so.
But suppose that the threat were credible -- that Bernie Sanders and Roland Burris, say, were prepared to carry it out. And suppose that you're Blanche Lincoln. Don't you now have something close to the best -- or perhaps the least bad -- of both worlds? Now you can vote against a bill which is unpopular in your state and dodge some of the blame for doing so, insisting that it was those no good
As for reconciliation, it has a whole host of problems. First of all, nobody is quite certain what provisions might be excised from the bill if reconciliation were the chosen path. The public option might not survive anyway. Or the public option might survive, but other provisions might be struck from the bill so as to make it untenable from either a political or a policy perspective.
Secondly, I expect that the reconciliation maneuver would play extremely poorly with the public. The health care bill is somewhat (although not overwhelmingly) unpopular to begin with. And believe it or not, the filibuster actually polls fairly well, at least in a theoretical sense. It might be one thing if the Republicans indeed exercised the filibuster to prevent a bill from coming to an up-or-down vote -- then you might score some rhetorical points. But it's another if you actively try to circumvent it via reconciliation or some sort of nuclear option. When you adopt a procedure that a majority opposes on process grounds in order to enact a bill that a plurality opposes on policy grounds, you're asking for a world of hurt.
Thirdly, it's not obvious that you'd be guaranteed 50 votes for passage under reconciliation. Any Democrats with misgivings about the bill itself or about the legitimacy of the reconciliation process (like Robert Byrd of West Virginia) could be expected to vote against the bill under reconciliation, which might leave it shy of a majority.
So what can advocates for the public option do? To be frank, I'm not sure that they can do all that much. This is mostly a matter of how Lincoln, Nelson and Lieberman wrestle with the politics of the issue. They hold almost all of the cards, and those that they don't hold are mostly held by the White House.
The reason I hold out some hope are because their objections to the public option are to varying degrees irrational. The health care bill isn't especially popular at the moment. But the public option is making its numbers better, and not worse.
And rightly or wrongly, progressive activists have adopted the public option to be the sine qua non of a "good" health care reform bill. I think that they're (mostly) wrong. The Senate's health care bill, even without a public option, would do a lot of good for a lot of people. And the public option, as currently constructed, would only enroll 3-4 million people, according to the CBO. It's a relatively minor provision, and one that, in its present, already-compromised state, I'd happily trade off for more comprehensive subsidies for the working poor, or a more robust Free Choice Amendment.
But I can't prevent other people from coming to their own conclusions. And rightly or wrongly, one of the greatest upsides to the Democrats in passing a health care bill is that it will help to activate the liberal base, in order to counteract the (already very active) conservative base in 2010. That upside will be diminished if the bill that Obama signs does not contain a public option.