Liberal senators and congressmen fought for the public option's inclusion in health care reform almost until the very end of the legislative process, adding signatures to a letter backing it in the weeks before the bill passed. But former Senate Majority Leader Tom Daschle, in an interview with ThinkProgress's Igor Volsky, seems to suggest that the public option was understood to be out of the picture much earlier.



DASCHLE: I don't think it was taken off the table completely. It was taken off the table as a result of the understanding that people had with the hospital association, with the insurance (AHIP), and others. I mean I think that part of the whole effort was based on a premise. That premise was, you had to have the stakeholders in the room and at the table. Lessons learned in past efforts is that without the stakeholders' active support rather than active opposition, it's almost impossible to get this job done. They wanted to keep those stakeholders in the room and this was the price some thought they had to pay. Now, it's debatable about whether all of these assertions and promises are accurate, but that was the calculation. I think there is probably a good deal of truth to it. You look at past efforts and the doctors and the hospitals, and the insurance companies all opposed health care reform. This time, in various degrees of enthusiasm, they supported it. And if I had to point out some of the key differences between then and now, it would be the most important examples of the difference.

This apparent discrepancy wouldn't be completely inconsistent with how health reform played out. While stakeholders gathered at the White House, and while the White House worked with Congressional leaders to draft and finalize the legislation, the final deal-making happened in Congress.

Case in point: the White House reached a deal with the prescription-drug industry in early summer, and then the deal was threatened in the fall. The reason being that all sides were limited so drastically by the pressures of Congress that any understanding was ultimately subject to support from the Senate and pro-life members of the House.

Deals and allegiances turned sharply at points in the reform process. AHIP, for instance, publicly supported health care reform at the outset (and continued to say it supported "health care reform"), but as specific details emerged and the White House began demonizing insurers as a political move to build public momentum (and as the public option remained popular), AHIP later assisted its members in funneling millions of dollars into anti-health-care-reform ads run by the Chamber of Commerce.

Even if the public option had been deemed "off the table" by the White House, the reform process was so volatile, and the vote-margins in Congress were so ultimately determinative, that no one seemed to be in control, and any such deal may not have had much finality to it anyway.

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