jbog,
I've read all the right-wing responses (e.g. cahi) to the data and I find the responses unconvincing. You can read the debate between Novack and Mahar yourself. Articles on cost efficiency come from reputable journals, including NEJM.
Really jbog, you've got your ideological blinders on. It's just common sense that with all the marketing and advertising and huge salaries and bonuses and commissions and the insane amount of paperwork to try to prevent "fraud," and all the wasted time that docs have to spend on justifying their treatment plans, that the private insurers would be so administratively cost inefficient, even with them piggybacking on Medicare for some decision-making.
But look, no analysis, no data, no argument in the world is going to convince right-wing ideologues that public plans are more cost-efficient than the private insurers.
So the rest is about politics. The lobbyists for the hospitals, the insurers, the pharmaceuticals, the device-makers, the AMA, etc. certainly have the upper-hand in stopping a public option. The question is will the progressive Dems make it an all-or-nothing proposition: either a public option or no healthcare reform bill. Because the progressives will argue that without a public option, there is simply no meaningful healthcare reform. This will force Obama/Emanuel's hand. But the political calculus is tricky for both sides. If Obama gets a "compromise" bill, then he can say that he did what he could, but the Repubs stopped really meaningful reform. I think that's Obama's best option. The worst that can happen is that people question his leadership skills, and even if the progressives are upset, where else can they go? The Repubs can argue that they, at least, put the brakes on "socilaized medicine." And the 2010 elections will be a bit of a referendum on whose argument wins out.
But if the progressive Dems force Obama's hand, he's got to make a tough decision. Does he go against his natural inclination to be a mediator and compromiser, and push for the public option? Or does he go for the "compromise" and risk alienating both his base and the "middle" who have clearly shown in the polls that they want a public option? If he loses on the public option and nothing gets passed, he get high marks for "standing on principle," but low marks for accomplishing nothing. His advantage here is that the Repubs and Blue Dog Dems get the blame and Obama may come out smelling pretty sweet. On the other hand, the populace could be pissed that nothing got done and question his "bi-partisanship" and his ability to get things done. In either case, if the progressive Dems force the issue, then Obama/Emanuel are faced with a tricky political choice.
And then there is the whole question of what if the House, where Pelosi and the whole Dem leadership seem remarkably united in favor of a public option, pass a bill with the public option, but the Senate does not. That conference committee will be something to behold. And Obama will again be put on the spot. Does he force the House Dems to compromise or does he "stand on principle" and look for 2010 for the voters to completely repudiate the Republicans for obstructing healthcare reform? Again, that's a difficult position, because the Repubs will surely argue that they tried to compromise and get something done, but the "far-Left" held out for "socialized medicine."
In any case, it figures to be an interesting political summer.
Bladerunner
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