The fight for inclusion of a public option is a waste of time. It’s a struggle to obtain what we’ve already got.

And I should have been pointing that out, but it slipped my mind what Amy Smoucha of Jobs with Justice wrote in a letter last December. I printed that letter, which included this paragraph:

Both the House and Senate bills bill create a national, non-profit, publicly accountable option for health insurance coverage.  The House bill contains a national public insurance option.  However, even in the Senate bill, people purchasing insurance in the Exchange will be able to choose from national plans, including at least one non-profit plan, supervised by the same department of the federal government that selects health insurance plans for federal employees.  Before the recent invention of a “public plan” demand, progressive health care activists were asking Congress to either open up Medicare for all or allow people to buy into the plans administered by the Office of Professional Management-the same plans that Congress and Federal employees have.  We just won a long-standing demand.

Because of my faulty memory, I have, like most of you, been calling McCaskill, urging her to sign the Bennet letter. I’ve even criticized Rep. Russ Carnahan for not signing the Polis/Pingree letter to the Senate urging the passage of the public option through reconciliation. My apologies to Rep. Carnahan.

The fact that I’m no longer working to get the public option included, though, doesn’t necessarily mean that I think the provision in the Senate bill solves the problem of rising costs. It might not help much. Public health experts disagree about whether the Senate bill will do much to contain costs, just as they disagree about whether the public option would do so. Most Americans like their private insurers and don’t want to be shoved into a public plan. Thus the number of participants might not be enough to give either one of them great bargaining power so that they could drive down costs.

That preference among Americans for keeping their insurance has driven the direction health care reform has taken under the Democrats. The Herndon Alliance polls Americans on health issues and reports to Democratic leaders on what messaging will succeed with the public. So:

When President Barack Obama says Americans can maintain their “choice” of doctors and insurance plans, he is using a Herndon strategy for wringing fear out of a system overhaul.

But if Americans get what “choice of doctors” means, they don’t have much of a clue what “public option” means. Trying to sell that idea confuses them and, thanks to the Republicans, divides them.

Besides, when we say “public option”, which public option are we even talking about? The term has always been a place holder for a variety of ideas, none of them very specific. At first, it was sort of a synonym for single payer; then the “robust public option” was an expansion of Medicare for those who wanted it; but rural areas, which get the short end of the financial stick when it comes to Medicare, protested. And rightly so. Finally the public option meant a government run program for those who cared to buy into it. But that provision was and is the weakest part of the reforms the bill offers.

What we need to understand is that the bill itself is hugely important to pass, and we dare not be complacent about getting it passed. If we have to give up the public option to get that done, so be it. The very last behavior we ought to indulge in is risking the passage of this bill with a stubborn insistence on a provision that is marginal; and besides, it’s already in there.