A Public Plan Cometh

The most interesting debates are those that occur within the ruling party.

In most cases, the safe bet on the winner is the wing with the most intense, clear-eyed and ideologically motivated agenda.

Which is why the most fascinating part of the health care debate is about to start within the Democratic Party.

The Democrats choice of either a public-private plan or a public plan for their health care reform will, largely determine whether, in their own view, they are successful or not in their unfulfilled (not for the lack of trying) quest to find their Holy Grail of health care reform.

Simply put, will the Senator Kennedy and Speaker Pelosi-wing of the Democratic Party agree that their hard work of taking back Congress and the White House, and their related store of political capital, be used to create hundreds of billions of dollars in transfer payments from the U.S. Treasury to the nation’s largest health insurers?

Is that what the Democratic Party will use this once in a decade shot at health care reform to do?  Is this what the Daily Kos and Internet bankrollers of the Obama campaign had in mind when they worked tirelessly for a Democratic White House and Congress?

Will this public-private partnership get the left closer to their dream of a Canadian-style health care system? Or will it entrench and empower the insurers for decades?

These transfer payments are exactly the result of a public-partnership. This is the Medicare Advantage model; the one many in the Democratic Party dislike so much. If the Democrats cannot de-fund the current public-private partnership (known as Medicare Advantage) only a few years after it passed, but instead radically expand it under a new, universal public-private partnership, then will they ever achieve their goal of a single payer, Socialized Medicine with a public-private partnership?

Most of all, industry wants to make a deal: they are offering most of what the Hill wants, just not a public plan option.  The question is: what happens if their deal is rejected?

The ideological choice to the Democrats seems clear. Seems clear, however, does not reveal the threat of choosing their natural ideological choice, that the nation’s insurers will unspool, and stop showing up and sitting around the table in nice business suits and white shirts and pretty skirts, but transform themselves in the equivalent of battle-axe-in-hand Vikings landing at a peaceful riverside farming village who go berserk.

Here is the real question the clear-eyed Democrats are asking themselves: are the insurers and others really up to the task of becoming Vikings?  They chuckle about how President Obama and Congress has shocked and awed and charmed the corporate leaders who fund the political battles.

Corporate America is confused, buffeted by economic and political pressures, and their first, second and third instinct is to make a deal, and when that does not work, either give up or declare victory. Even the cap and trade tax has not produced a serious political response, perhaps a sign of things to come in health care?

There is no industry group that has gone to the mat to fight anything, and the Hill and the White House are betting there will not be one.

As far as the Democrats are concerned, they are making a good bet. They see economic and industry interests where feet-shufflers and shoe-starers are the order of the day. Politically correct CEOs are trained to avoid political fights — THOU SHALL NOT — and they are neither trained for it nor do they have the ability to see even the outline of the battlefield.  And pride prevents them from not knowing what they do not know.

In 2009, fighting industry is a misnomer; instead, it is more like taking a toy from a child whose teacher is insisting the child hand it over.

And the bait and switch dance has already begun. Put the public option in the House version of the bill. Leave it out of the Senate version, or not.

Then, keep the public option in the House-Senate conference. (President Obama, Speaker Pelosi and Senator Kennedy are on record supporting the public plan.)

This dance of legislation will mimic the same tactics used on the taxing of health care benefits, which is the only way that the health care reform plan can be paid for – at least on paper. This is an example of something that President Obama campaigned against, and now will agree to — only so health care reform can be paid for.  Oh, how things change, and so quickly in this big game of health care reform.

The real question is whether the executives in industry realize their stock options, their jobs, their houses, their children’s top schooling and their spouses all depend on their companies prospering.  If they really believe that a public plan will end their company’s livelihood, then they will open their check books and fund a war.

But the CEOs do not have the will, nor do they have the vision or the strength to go through a grinding battle.  That is why they need mercenaries — or maybe the executives will just retire or be retrained.  Industry may or may not realize they cannot change their “at-the-table” players into the warrior class – and they will waste precious time by attempting to get those who may never be combat ready to become combat ready.  But time is short and most of the battlefield has been conceded already, and industry is not ready to fight. 

Even if they decide to go to the mat, the health care industry has been 5th columned. When and if industry ever starts to plan for a serious battle, then the Hill and the White House will have their people in the room, reporting in, in real-time.  (It is a great luxury to read your enemy’s plans and to help to formulate them.)

In short, the long march to be victorious with a universal public payer health care is almost over for the Democrats.  The captains of industry or robber barons of the health care world soon will be squeezed smaller and smaller by the biggest force in health care in the United States: our government.

And, just as Marx predicted, industry sold the rope by which their companies will be swinging.  Given the tiny number of executives who read Karl Marx or Carl von Clausewitz, the outcome was preordained.  It isn’t even a fair fight.