Behind Closed Doors

“No one knows what goes on behind closed doors.” So wrote Kenny O’Dell in the classic country and western song made famous by Charlie Rich in 1973. It describes quite nicely what’s going on in the Senate right now.

For reasons unclear to many of us -- but probably comprising a mixture of honest conviction, limelight addiction, and fear of an agitated constituency whipped up by President’s Obama’s critics desperate to make him look bad at any cost -- a number of Democratic and all Republican members of the United States Senate are determined to stonewall the public option in the senate’s pending health care reform bill.

Behind closed doors, Majority Leader Harry Reid (D-NV) is trying to cobble together some kind of compromise language that will get the 60 votes needed to avoid death by filibuster. This is not a transparent process. It can’t be. The stakes are too high, the egos too prickly, the situation too fluid.

It’s important to keep the focus on the end game. The semi-end game is to get a bill voted out of the Senate, that can go to conference with the House, so that a single bill can then go back to each house of congress for a final vote.

The House bill has a respectable (if far from perfect) public option already. The Senate bill needs to have a whisper, a wink, or a nod toward a public option as well, to ensure that some form of public option makes it into the final bill, which will not be subject to further amendment. My guess is that the whisper, wink, or nod will be one of the following:

1. Public option by trigger. That is, there will be no public option up front, but one would be invoked if the private health insurance industry fails to deliver health insurance at an affordable price for all. This could win over Sen. Olympia Snowe (R-ME) and possibly her colleague, Susan Collins (R-ME). It might not be all that bad, either, because the private health insurance industry is almost certain to fail, and the public option will be triggered automatically. The downside to this option is the delay, but the short term pain of no public option will probably be followed by the certainty of getting it eventually.

2. Public option by opt-out or opt-in. This would mean that each state would decide to participate or not. I haven’t heard any Democrat or Independent say they absolutely will not support a bill that gives states the option to not participate in the public option. The downside here is that some states might still leave their citizens without health insurance. In Texas, that would mean at least 1 out of every 4 people. On the other hand, it brings the public option to a more local level, where leverage could be more effective, and where alternatives, like public clinics, can be more creative.

3. Semi-private co-operatives, which would look and feel like public options, but would not be funded by the government. The downside to these is that every economist and disinterested analyst who has looked at this alternative feels that it is highly likely to fail, for lack of a critical mass. Again, this might not be so bad, if it is coupled to an alternative, like a trigger, that invokes a public option eventually.

Never underestimate the creativity of the legislative process. I said months ago that what is going to transpire through the fall and early winter is not going to be pretty. But as long as the debate is still joined, momentum for reform is being maintained. What’s going on behind closed doors is the relentless effort to keep that momentum going.