Robert Kuttner:

[A] new Times-CBS poll [shows] that 72 percent of Americans favored a government run health plan comparable to Medicare, which would be available to everyone....

However, that’s only the beginning of the story. The [health care] reform package, as drafted by the Obama administration and the House leadership, is dubious legislation even with the inclusion of a public option. Basically, it leaves the two worst aspects of the system intact. First, private insurers will continue to dominate. Second, most people will continue to get their insurance through their employers. Given these two bedrock realities, there is no way that the bill can make serious inroads on cost without cutting back on care. [Mission accomplished!] The high cost of the approach is already causing key legislators to back off. ...

Also, as my American Prospect colleague Paul Starr warns, a mixed system with a public option effectively invites the most expensive and hard-to-treat people to opt for the public plan, while private insurers will seek to insure the young and the healthy. This is a familiar problem known as adverse selection. [Familiar to everybody but the administration and career liberals, of course.] The private insurers will then smugly point out that the public plan is less “efficient,” when in fact it simply will have a more costly population. The only way to avoid this problem is to have everyone in the same universal plan—what’s otherwise known as a single-payer plan.

The public option is a not-very-good second best—because our leading liberal politicians lack the nerve to embrace the one reform that simultaneously solves the problem of cost, quality, and universal inclusion. The policy that dare not speak its name is of course comprehensive national health insurance, or Medicare-for-All. ...

The Times-CBS poll is evidence that [Medicare-for-All] is what more than two Americans in three really want. Most voters have not followed the nuances of how the public option in the Obama plan would compete with private insurance. The poll simply indicates that voters want access to a straight-up, Medicare-style plan to be available to one and all. In past polls, when Times-CBS pollsters ask whether people favor national health insurance, responses generally favor Medicare-for-All by margins of about two-to-one.

In the current debate, liberals find themselves fighting to keep the public option alive, so that some form of efficient, publicly-run health insurance will stay in the mix—but knowing that it is embedded in a reform package that is far more costly and inefficient than it should have been. Instead of validating the common sense and reformist demands of ordinary Americans and identifying the insurance, drug, and corporate elites as the obstacles to real reform, too many of our ["]liberal["] ["]leaders["] from President Obama on down hope to co-opt business elites with a convoluted scheme that undermines the efficiencies of a comprehensive and universal system. And just wait until it gets watered down further in order to retain the support of these same elites. A plan that all of these groups would endorse would not be worth having.

Exactly. And not only will public options postpone a real solution for another 15 years or so and kill a lot of people, it's being imposed by an illegitimate process: Single payer advocates have been excluded and censored throughout. We can't even get the CBO to score the single payer bill, HR676!

So what’s the matter with our politicians? Why are the people so far ahead of their elected leaders on this one? One reason, as usual, is money. The combination of the insurance industry, the drug industry, the American Medical Association, the hospital lobby—all of whom oppose Medicare-for-All—represents a huge amount of political spending. It takes a brave politician to face down all of these industries, even though the people are on the side of real reform. The AMA’s position is especially shameful, since the professional societies that represent most actual physicians favor national health insurance.

The second reason that liberal politicians wimp out on single payer is that the self-styled realists in this debate have decided that Medicare-for-All, even if it’s the first-best system, is too hard politically. But think about it. Has the administration picked up one Republican vote by supporting the present system plus a public option? Hardly. The current House leadership bill, offering a mixed system, with a robust public option, a requirement that employers provide good insurance or pay a tax, and that insurers not discriminate against pre-existing conditions, is just as heavy a political lift as national health insurance—and far inferior policy. So why not just go for the first-best?

Exactly.

And watch how the Overton Window is working, here:

The advocates of Medicare-for-All have become something of an embarrassment to the liberals. The White House forum on health reform on March 5th, which boasted a diverse range of viewpoints, including representatives of the Business Roundtable, the health insurance industry, the drug lobby, as well as a broad spectrum of business, labor and Congressional leaders, left advocates of Medicare-for-All banging on the door. None were included, despite requests for invitations.

When Sen. Bernie Sanders recently arranged for five prominent advocates of national health insurance to have a courtesy meeting with Senate Finance Committee Chair Max Baucus, the story was newsworthy because the political elite usually pretends that this viewpoint doesn’t exist, much less that it represents the desires of two Americans in three. The mainstream media have also colluded in the general effort to keep the single-payer option out of the limelight. The organization FAIR recently published an important study in its heroic magazine, “Extra”, titled “Media Blackout on Single-Payer Healthcare.”

Indeed, the Sunday New York Times-CBS poll didn’t even offer Medicare-for-All as a free-standing option. It took the Obama position as the left edge of the debate.

Of course, with our tribunes of the people in the blogosphere fighting hard, each and every day, to make sure all sides are heard, instead of merely regurgitating the administration's public option pablum or falling in puppy love with whatever AstroTurf organization du jour ... Oh, wait. Sorry.

Only by having a comprehensive system can we marry quality, cost-effective care, and universal access. One of these days, a national leader will have the nerve to embrace national health insurance and fight for it. Until then, we will keep paying more money for less care, and liberals will defend reforms they themselves scarcely believe in.

Maybe Bernie Sanders will run on this in 2012. He'll get my vote!

NOTE Again, I can't answer that question; the continuing rain has shorted out the circuits in my mental telepathy helmet. Could it be that public option advocates are less concerned with policy than with party loyalty? I don't know that either. What I do know is that in the blogosphere, public option is framed as the pragmatic choice. This is so wrong it's not even right: The pragmatic choice is to shove the Overton Window as hard left as possible, so that the best outcome is achieved during the sausage-making process in Versailles. The administration has already pre-compromised on this issue, and they don't need any help from us.