For more than a year, President Obama remained on the sidelines of the health care debate -- chiming in now and again with sometimes-inspired, sometimes-disappointing rhetoric about broad values while members of Congress did the heavy lifting.
Now, the president has finally weighed in with "a plan."
But it is not enough.
The White House is making a big deal about what's being labeled "The President's Proposal," which the administration announced with much fanfare Monday.
According to the White House, the Obama plan does a lot:
• It makes insurance more affordable by providing the largest middle class tax cut for health care in history, reducing premium costs for tens of millions of families and small business owners who are priced out of coverage today. This helps over 31 million Americans afford health care who do not get it today – and makes coverage more affordable for many more.
• It sets up a new competitive health insurance market giving tens of millions of Americans the exact same insurance choices that members of Congress will have.
• It brings greater accountability to health care by laying out commonsense rules of the road to keep premiums down and prevent insurance industry abuses and denial of care.
• It will end discrimination against Americans with pre-existing conditions.
• It puts our budget and economy on a more stable path by reducing the deficit by $100 billion over the next ten years – and about $1 trillion over the second decade – by cutting government overspending and reining in waste, fraud and abuse.
But the real news is what it does not do.
Despite urging from House leaders and a growing number of senators, "The President's Plan" does not include a public option.
Nor does it bow in any meaningful way to progressive proposals to expand access to Medicare and Medicaid.
In other words, the president has opted for the Senate's exceptionally compromised approach, rather than the bolder bill produced by the House.This is not exactly shocking. The president abandoned serious discussion of the public option several months ago. But the failure to even reference moves to develop a federally-funded alternative to private insurance represents a clear embrace of the Senate stance.
Obama does tinker with some of the worst elements of the Senate bill. For instance, he proposes eliminating the special deal regarding Medicare spending in Nebraska that was cut to win the vote of Senator Ben Nelson, D-Nebraska.
Obama also proposes to delay until 2018 the tax on high-end insurance plans that was passionately opposed by organized labor.
One place where Obama's embrace of the Senate bill is good news is on the issue of reproductive rights.
The president's plan retains Senate language that is less restrictive regarding the use of federal money for abortion than what is contained in the House bill.
When all is said and done, however, "The President's Plan" is the Senate bill with the rough edges shaved off.
That's not exactly great news, as the Senate bill was not exactly a great bill. In fact, it has been condemned by serious reformers as a huge payoff for existing insurance and health-care industries that contains no real mechanism (in the form of a public option) for holding then to account.
So: Is "The President's Plan" the final bill?
The president's aides admit that this "plan" is really just a framing document for the bipartisan, televised health care summit where Obama will meet with Democratic and Republican leaders in the House and Senate to discuss reform.
"This is the opening bid for the health meeting," says White House Communications Director Dan Pfeiffer. "We took our best shot at bridging the differences. It makes some strong steps to improving the final product... The president is coming to the meeting with an open mind."
In other words, this is where the president's head is at as of Monday, February 22.
It's good that Obama has finally produced a proposal.
It's bad that Obama has not produced a stronger proposal.
But what really matters now is keeping up the pressure for improvements -- especially along Medicare-for-All lines -- as the long debate over health-care reform enters the next stage.
To that end, Congressman Eric Massa, D-New York, an ardent backer of real reform -- in the form of a single-payer plan -- offers these suggestions to frustrated activists:
So here we are in the middle of February, 2010. The House and Senate have passed health care bills similar in less important sections but differing on crucial aspects. What now?
I suggest a "three track" approach.
The first is that in the short term, we support any realistic initiatives to improve either existing bill. And we also endorse new single bills, such as one removing the anti-trust protection for private health insurance and medical malpractice insurance firms. Another should end private insurance exclusions because of pre-existing conditions and annual and life-time caps on benefits. I am working on these now.
The second track is for activists to work hard in states where single-payer healthcare has the greatest public support. A national agency should coordinate local action and raise national funds for those states best positioned to be successful. Concentration of funding and organizing on these "best bets" states is crucial.
Success in even one state would be monumental.
Third is a complimentary federal track. We support a bill allowing the federal government to recognize and encourage, with money and technical assistance, integrated state systems meeting certain criteria. States should be allowed to fully incorporate their existing Medicaid and SCHIP programs and funding into a single comprehensive program, and qualify for additional federal dollars. In such cases, private insurance becomes subordinate to this public program. Parallel to this, a bill expanding age eligibility for Medicare is crucial.
At the same time we must point out that this approach requires neither individual nor employer mandates.
The only requirement is that every enrolled citizen pay toward the general cost of health care.
Finally, we must continue to make logically sound, careful arguments for health reform, using the best data and studies.
That means focusing on the health needs of 300 million Americans. Individual cases can be used, but only to illustrate conclusions based on a wide range of data.
By doing all these together, progress is still possible.
Massa's been working with Progressive Democrats of America and other groups to keep the pressure on Congress and the White House to do more.
Massa's message is a good one. Even those who might disagree with him on specifics should recognize that "The President's Plan" is not the final word.
It is important that Obama is still talking about trying to repair a broken health care system. And it is important that some of what he is saying has merit.
Of course, his cautious approach may be frustrating. But frustration with this president is not exactly a new experience.
Progressives need to recognize that, while Obama will not lead, he but may yet be led in the right direction.
What Obama has done is frame the debate a bit more.
Now, real reformers must provide a better frame -- and focus. To that end, they must increase the pressure on the president and Congress to abandon the worst compromises and to seek the best fixes.