An Open Letter On The Public Option To David Axelrod

As a lifelong FDR Democrat, I won't support any health care bill that doesn't have a robust public option. I'd much rather see a bill without one go down to defeat, than have a bill pass without one.
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Dear David,

You sent me an email on healthcare from the White House last month, one that went out to millions of people. Now I'm replying by sending one to you. You told me it was time for a reality check. Now I'm telling you the same thing. My message is very simple. As a lifelong FDR Democrat, I won't support any health care bill that doesn't have a robust public option. I'd much rather see a bill without one go down to defeat, than have a bill pass without one.

Apparently, by accounts in Politico and elsewhere, you've been deputized to let it be known that the public option is dead, and to try to appease the majority of us Americans who support it (by 55 to 41 percent, according to a very recent CNN poll) by assuring us that its "spirit" lives on. Sorry, David, that's not good enough. Neither is the "trigger" the White House is discussing with Sen. Snowe. You can be sure that's one trigger that will never be pulled.

I've read that if no bill becomes law, that would be a crushing blow to Obama's presidency. Maybe so. That would be too bad. But we liberals might not knock ourselves out to keep it from happening. Trouble is, you people don't get it. You may have to learn the hard way. Stop worrying about Grassley and Enzi and Rush and Sean and Baucus and Conrad, and Billy Tauzin and Karen Ignagni and their hundreds of lobbyists; and start worrying about the people who worked, paid and voted to put you in the White House. We can live without you if we have to. After all, we survived eight years of George W. Bush. But you folks can't continue to live in that big house on Pennsylvania Avenue without us!

Liberals have been waiting since FDR for universal health care. Heck, we can wait a few years longer -- especially those of us on a public program called Medicare, courtesy of one of your predecessors. It's wonderful. We ought to have its equivalent for everybody. I know that, unfortunately, that's not politically possible right now (partly because, god forbid, the next head of United Healthcare might not then be able to retire with $1.7 billion in his pension). But at least there's got to be a public option: a chance for some people to have the price advantages of a cheaper government plan soon, and a camel's nose under the tent so we can move toward Medicare for everybody someday.

A recent report said that in more than 90 percent of markets around the country, a single private health insurance firm had a near-monopoly -- not enough competition to significantly keep prices down. Here's how reporter Ezra Klein described the situation in his Washington Post article:

The Justice Department judges an industry "highly concentrated" if a single company controls more than 42 percent of the market. By that definition, 94 percent of statewide insurance markets are highly concentrated. A recent study by the advocacy organization Health Care for America Now showed that in Indiana, WellPoint controls 60 percent of the insurance market; in Iowa, Wellmark accounts for 71 percent; and in Alabama, Blue Cross/Blue Shield holds 83 percent. In the past 13 years, there have been more than 400 corporate mergers involving health insurers.

Then too, individual insurance costs far more than many families can afford. Besides which, a lot of small businesses have problems providing employees with affordable insurance.

That's not good enough. The public option, if it's robust enough, might just make insurance affordable to people who don't have jobs or can't get decent (if any) coverage through employers. If not, let's forget the whole thing for now. Until the day enough Americans get so fed up with the current system that's needlessly hurting and killing their families, that they decide to catch up with the rest of the civilized world and demand something better.

Six months ago, I'd never heard of a public option. Neither had anyone else. But you folks convinced me -- including Obama in his July 18 weekly address -- that one was absolutely necessary. Do you recall what the president said? Let me refresh your memory:

...any plan I sign must include...a public option to increase competition and keep insurance companies honest...And that's why we'll put an end to the worst practices of the insurance industry.

Too bad that just when you got me absolutely convinced, you guys began backing away from it.

You'd better reverse course again. I read that Obama has scheduled a health care speech to Congress next week and a talk before the AFL-CIO. He'd better come out in support of a robust public option.

If not, a lot of us liberal Democrats might just conclude that we can't really trust your guy. Some of us might just stop caring if the Republicans gain seats or take over Congress next year, and stop bothering to work hard to see that they don't. We'd be unhappy with such results, but we'd have to acknowledge that the Dems got what they deserved. And if some GOP lunatic beats Obama in 2012, we'll just have to grin and bear it, saying that's just the American Way.

Those of us who say this will, of course, be insured, from Medicare and elsewhere, so we won't personally suffer (except, of course, when we get cheated or our health put at risk by health care companies -- can you really trust Big Pharma's $80 billion deal with you when the biggest pharma of them all, Pfizer, just paid a record $2.3 billion in fines for cheating? And didn't you make a deal with hospitals? And didn't the largest hospital chain in America, HCA, pay $1.7 billion in fines for Medicare fraud a few years ago? Sorry to bring up stuff like that.) Continuing the current system will just insure that millions more Americans -- including kids -- will continue to be cheated, and to suffer and die needlessly.

One thing more. Obama's seven months in office have resulted in growing disillusionment among the liberals who worked hardest to get him elected. There's no move to close Guantanamo. The Iraq war, which Obama promised to "end in 2009," shows no sign of ending. There's no light at the end of the Afghan tunnel, despite increasing anti-war sentiment at home.

The economy continues to edge downward, although a lot less than before. Growing unemployment is not expected to turn around for months. Foreclosures still mount. Banks still don't deal with toxic assets, and credit remains tight. Deficits continue to grow. Republicans have made much of all these problems. Independents aren't happy about them either. Now, especially if Obama folds like a paper napkin on the public option, that could be the last straw that causes many liberals to throw up their hands and stop fighting.

Liberals' strong support of Obama is a political love affair. So he should beware of a strong, angry, jilted lover. As columnist Eugene Robinson wrote:

Giving up on the public option might be expedient. But we didn't elect Obama to be an expedient president. We elected him to be a great one.

And if he turns out to be just another pol, then we can do without him.


Sandy Goodman
Rockville MD

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