Yesterday, right before I went to bed, I saw an ominous CNN report that stated that, if the public option was not included in this health care reform package, then "as many as 100" progressive Democrats would not vote for it, and that if the public option WAS included, then as many as 68 conservative Democrats (the so-called Blue Dogs) would vote against it, along with the entire Republican block.

Scary stuff.  If that were true, then clearly we wouldn't get any health care reform at all, which would mean that my daughter and millions of other Americans would still go around with no health insurance at all, even though my daughter--like so many uninsured Americans--works 50 to 60 hours a week.

At three a.m. I woke up, and that was pretty much it for the night.  As I lay there, staring up at the darkened ceiling, I suddenly got this mental image of President Obama, way way up in the circus spotlight, endeavoring a tightrope walk, striving mightily to balance himself with a long pole, but every time that pole dipped toward the right, the audience to the left would scream "TRAITOR! BETRAYOR! LIAR!" and throw old Obama '08 campaign buttons at him; then every time the pole would dip toward the left, the audience to the right would spring to their feet, 9mm firearms strapped to their thighs and AR-15's slung over their shoulders, and shout, "NAZI! HITLER! SOCIALIST! NOT-REALLY-AN-AMERICAN CLOSET TERRORIST PRETENDER! LIAR!"

Below, a phalanx of TV camera crews salivated, close-up lenses focused, waiting breathlessly to see if he would plunge to his death.  Because THAT, of course, would be the real story.

Standing silently in the rain, outside the circus tent, throngs of the uninsured and underinsured, ignored and unseen by the agitated crowds within, held their breaths to see what was to be their fate.  I could see my daughter among them, wet hair plastered to her face, pale from working too hard, as always, and our eyes met, and I knew we could not let her or the rest of them down.

And so, we Americans remain poised in this trembling moment of history, and wonder what is to become of all of us.

I did try to go back to sleep, but I could not get that mental picture out of my mind.  Finally, when there was enough light for me to get up and move around without disturbing my sleeping husband (nothin' keeps that man awake), I turned on the computer and went to work.

It could not be that simple, I determined.  It could not be that either-or, that black or white.  Nothing ever is, no matter how cut-and-dried the news packaging is.

And what I found not only informed me beyond most of what I've seen in coverage of this debate, but actually served to soothe my fears considerably, so naturally, I'm passing it on to you guys.

First of all, the bad news.

One thing I love about TPM Cafe is that most of the participants are very well informed and well educated, so I don't need to reiterate what many of you already know:  that the votes for the public option are not there.

Still, that matter is up for debate--I've seen both sides--so I turned to someone whose voice I learned to trust implicitely during the campaign--Nate Silver over at FiveThirtyEight.com.  His analysis:  Life After the Death of the Public Option, is the single most comprehensive--and enlightening--explanation of what that actually means that I have found anywhere. 

It not only makes sense, but if offers encouragement.

First he breaks down, vote by vote, in the House and the Senate where the problem exists and why it's real.  "It's an unpleasant truth," he states, "But just because it's an unpleasant truth does not mean that it's not the truth."

Then, he explains why health care reform without a public option is still reform:

Forget politics for a moment -- what about from a policy standpoint? The fundamental accomplishments of a public option-less bill would be to (1) ensure that no American could be denied coverage because of a pre-existing condition or because they became sick; (2) subsidize health insurance coverage for millions of poor and middle-class Americans.

These are major, major accomplishments. Arguably, they are accomplished at too great a cost. But let's look at it like this. The CBO estimates that the public option would save about $150 billion over the next ten years -- that's roughly $1,100 for every taxpayer. I'm certainly not thrilled to have to pay an additional $1,100 in taxes because some Blue Dog Democrats want to placate their friends in the insurance industry. But I think the good in this health care bill -- the move toward universal-ish coverage, the cost-control provisions -- is worth a heck of a lot more than $1,100.


He then explains why ramming through a public-option bill in the House would still wind up in defeat in the Senate, and why the cost in the long run would be too high--and I'm not talking money-cost.

He also addresses the all-or-nothing stance of the ideologues among us that Dems have to take a stance somewhere and that if not here, then where???

But don't progressives need to draw a line in the sand somewhere? I'm sympathetic to this argument from a game-theory standpoint. But (1) lines in the sand won't mean anything if they're washed to sea by a wave-like 2010 election; and (2) I'm not persuaded that the lack of progressive willpower is responsible for compromises on bills like health care, climate, and the stimulus package. The stimulus package passed the House with only 26 more votes than were required for passage and had just one vote to spare in the Senate. The cap-and-trade bill passed with just one extra vote in the House and has yet to pass the Senate (and probably won't). A health care bill, even under somewhat best-case scenarios and even without a public option, is unlikely to gather more than about 230-240 votes in the House and perhaps 62-64 in the Senate.

It doesn't seem to me as though the Democratic leadership (including President Obama) is unnecessarily watering down bills for the sake of achieving a "bipartisan" outcome. It seems, rather, that they're calibrating things relatively well, and squeezing about the most juice they can out of these initiatives given the institutional imperatives of the Congress

Of course, we don't have to accept anything as unchangeable when it comes to politics, and Silver takes note of that fact:

By all means, try to change those institutional imperatives. Organize primary challenges against Senators and Representatives who are too conservative relative to their districts; these can have somewhat dramatic -- if probably somewhat temporary -- effects on Congressional behavior. Try to build some momentum against the filibuster. Expose Senators and Representatives who are voting against the best interests of their district because of special-interest money. Push Democrats to end the seniority system in its selection of committee chairs and floor leaders. And work on shifting the Overton window where you can. But I don't think the problem is that progressives are disempowered. It's simply that they don't constitute a majority. Non-Blue Dog Democrats make up 47 percent of the House. They probably do make up a majority of the Senate (although this is arbitrary; the Blue Dogs aren't formally active in the upper chamber), but in the Senate, a mere majority isn't good enough -- you need a supermajority

Finally, Silver holds out hope that I do not think we should dismiss out of hand just because of our own impatience:

Incrementalism seems to be a popular meme these days -- could the public option do better as a standalone provision? While bearing in mind that bargaining is the third stage of grief, this seems to me to be a somewhat realistic hope, especially if Barack Obama is elected to a second term. If a health care reform bill passes, then the government will paying for private insurance coverage for some low-to-middle income individuals. This will tend to give everyone a more direct interest in cost containment: if a low-income family's insurance coverage is costing more than it should because of the absence of competition from a public option, it will be the taxpayers making up the difference. Of course, there would be some people arguing to blow the whole thing up entirely for this reason. But if someone then proposed a public option -- a provision that would spare $150 billion from the public dole and which would give consumers more choices -- it would seem to have a fairly compelling case. Part of the problem the public option faces is that it's a somewhat popular, cost-reducing measure which is mired in a somewhat unpopular, thousand-page, $900 billion bill. When taken as a standalone measure, its cost savings would be more transparent and its opponents would have less ability to confuse the public about its costs and benefits.

Now, I know some of you out there already have your blood boiling over this because you think if we don't do EVERYTHING now then we will never get another chance in most of our lifetimes to do it AT ALL.

Hang in there with me.  I know it takes longer than the av-er-age blogpost to read through my stuff, but I promise to make it worth your while.

First, a defense of the Obama administration strategy, which I found in the L.A. Times: "Obama's Health-Care Trade-Off."

The article begins by pointing out that so many aspects of health insurance reform that is included in all versions of the bill, such as not being denied due to pre-existing conditions, is not necessarily set in stone, and that by compromising on something like the public plan, Obama gets far greater leverage to insist on across-the-board reform, particularly with conservative Dems and so-called "centrist" Dems, as well as with a tiny handful of Republicans, (who, in spite of their rhetoric, will not all vote en masse against something that they know could really hurt them in the next election).

Centrist Democrats on Monday said they welcomed the new White House flexibility.

Rep. Jason Altmire (D-Pa.), a second-term lawmaker from a swing district, said: "It's going to bring votes." Altmire, who was one of three Democrats to vote against the bill in the House Education and Labor Committee, said that the government plan had "become a flash point."

Families USA Executive Director Ron Pollack, a leading consumer advocate who has been pushing a healthcare overhaul for decades, said his group had been distributing a memo touting the "10 Reasons to Support the Health Care Reform Bills." A government plan was only one of them.

"The health reform bills have many critical factors designed to make healthcare more accessible and more affordable," Pollack said in an interview. He and others noted that the bills working their way through the House and Senate included provisions that would transform the way Americans get health insurance -- even without a government plan.

"The public plan is not the essential element of reform," said Jim Kessler, vice president for policy at Third Way, a centrist Democratic think tank in Washington.

When it comes to strategy, many lawmakers long have seen a concession on the government-run plan as essential to getting any healthcare bill through the Senate, where 60 votes are needed to ensure passage.

All 40 Senate Republicans oppose the public option, as do some Democrats. Majority Leader Harry Reid (D-Nev.) has been working to overcome political obstacles in the Senate, where a small bipartisan group of lawmakers has been trying to reach a compromise.

"While Sen. Reid supports a public option, he also supports bipartisan compromise healthcare reform that cuts cost and provides coverage for all Americans," said Reid spokesman Jim Manley. "There are different proposals on the table that can accomplish that goal."

Which leads of course, to the obvious question, and that is, What about those progressives and liberals who are counting on a public option?

First, the bad news:

Obama's willingness to jettison the public option if necessary risks alienating some in his liberal base.

Jed Lewison, a liberal blogger, said that if a healthcare bill passed without a government-run program, grass-roots support for future Obama objectives may be more tepid.

"People's intensity will definitely diminish," Lewison said. "People have been listening to strong arguments for the public option coming from the administration. And they believe those arguments. If it comes down to where people feel like in the last few yards of the field, the rug was pulled out from underneath them, and they may not be as willing to work hard the next time around."

Lord knows, that's putting it mildly.  Read a few headlines on progressive blogs or tune in to shows like Rachel Maddow and Ed Schultz and you'll get an earful of rage every bit as scathing as what Obama faces on the right.

But see, this is where you have to think outside the box, shake off that "either-or" mindset, and study a little bit of history while you are at it.

In Newsweek, Jonathan Alter analyzes not just how Obama should sell health care reform, but how this bill compares with a few other pieces of landmark legislation of the past:

History suggests that major social policy unfolds on a continuum. The Social Security Act of 1935 disappointed liberal New Dealers because what was called "old-age insurance" covered only about half the adult population. It excluded farmhands, domestics, employees of small businesses, and most blacks. That was because FDR needed the votes of Southern Democrats, the Blue Dogs of their day. (The bill cleared the House Ways and Means Committee with only one Republican vote.) Similarly, the Civil Rights Act of 1957, immortalized in Robert Caro's Master of the Senate, was weak tea. It had to be strengthened by the Civil Rights Act of 1964 and the Voting Rights Act of 1965. In the later bills, Lyndon Johnson betrayed Southerners he had made deals with in 1957. If Nancy Pelosi can't break Rahm Emanuel's promise to Big Pharma's Billy Tauzin this year, she can try to break it in the future. And Tauzin will lobby for more favors as the all-important new regulations are issued. Nothing in Washington is ever set in stone.

The only thing that should be unbreakable in a piece of legislation is the principle behind it. In the case of Social Security, it was the security and peace of mind that came with the knowledge of a guaranteed old-age benefit. (Ronald Reagan and George W. Bush got slam-dunked when they tried to mess with that.) In the civil-rights bills, the principle was no discrimination on the basis of an unavoidable, preexisting "condition" like race.

The core principle behind health-care reform is—or should be—a combination of Social Security insurance and civil rights. Passage would end the shameful era in our nation's history when we discriminated against people for no other reason than that they were sick. A decade from now, we will look back in wonder that we once lived in a country where half of all personal bankruptcies were caused by illness, where Americans lacked the basic security of knowing that if they lost their jobs they wouldn't have to sell the house to pay for the medical treatments to keep them alive. We'll look back in wonder—that is, if we pass the bill.

Again, I hear you out there, screeching at me that if we don't do it NOW, we will NEVER do it.

I do not, however, hear any howling about HOW it is to get done.

And that, my friends, is where the divide-and-conquer part comes in.

Today's Huffington Post blog, "The News of Its Death is Greatly Exaggerated," by Mike Lux, author of The Progressive Revolution: How the Best in America Came to Be, is the smartest, savviest, shrewdest thing I've read yet on this subject.

First, he draws a scenario about what will happen if progressive Dems hold their ground, against all odds, to pass the bill as they want it to stand:

1. The House will find the votes to pass a comprehensive bill with a public option soon after they get back from August recess. That will be reasonably easy, because Pelosi will be able to peel off a reasonable number of Blue Dogs, many of whom have said they would support a public option, to vote for the bill.

2. The Senate will find the votes to pass a convoluted, tortured, unworkable bill, not only with no public option but so messed up and compromised to be unworkable anyway. This is less certain than number one, but Democrats will probably find a way to pass something.

3. The conference committee will sit for several weeks as Senators like Conrad say we will never pass a public option, House progressives says we will never pass something without a public option, and the White House, Pelosi, Reid, and conference committee members work out details to try to get something passed.

At that point, either the bill is dead, which would be an act of suicide for Democrats in both houses, OR, they look for a much smarter, clever way to get it done without having some sort of OK Corrall gunfight.

Lux writes:

A. The first is that conservative Senators are given a fig leaf compromise on the public option, so that they can say to people they forced a compromise, and then are brought over with all kinds of other incentives that make them more comfortable with the bigger bill.

B. The second is that the conference committee simply breaks the bill in half, one half being the less controversial part that everyone agrees upon, the other being the public option and the financing, both of which can go through the reconciliation process. Then Obama and Reid muscle the 50 votes they need for support.

WHAT was that again?

Break the bill IN HALF???

Lux says, not only yes, but HELL yes:

None of this is easy, and none of it is pretty, but having been through a ton of these kinds of issue fights, both from inside the Clinton White House and from the outside, I can tell you that all of this is doable. These kinds of rhetorical logjams happen all the time, where it looks like the House and the Senate are both unalterably dug in, and then magically deals get done. On important bills, effective Presidents and Congressional leaders find some tough-to-thread-the-needle sweet spot, or they use some uncomfortable or inelegant legislative tool, and things that matter can get done. The media and establishment conventional wisdom, which always tends toward the dire and toward the conservative scenarios, is sometimes proven wrong. So ye of little faith, do not give up hope. The worst thing sometimes happens, but not always. Politicians sometimes sell people out, but not always. Keep fighting for the public option.

So, again, I think that in many instances of liberal outrage, part of the problem is simply a basic lack of understanding about how the legislative process can work--and I include myself in that group, because I didn't have a clear picture of it myself until I did my homework. 

It does not have to be all-or-nothing, now-or-never.

There are nuances and options of all sorts to accomplish the same basic goals.  In the final analysis, I'm looking up at Obama on that tightrope, right?  And I know that sometimes that pole will dip toward the left, and sometimes it will dip toward the right, but eventually, he will stabilize it into a balanced, horizontal hold that will enable him to get to his destination.

And sure, the media-types will be disappointed, because they were hoping he would fall, since it makes a better B-roll story, and there will be die-hards on both sides who won't be happy no matter HOW he gets across that rope...but when the spotlight fades, and the audience's attention will be held, spellbound, by the next act...listen. 

Listen closely.

You will hear it.

Cheers...wafting in from outside the tent, as all those people standing out in the rain realize that the storm is over, and they can come in out of the cold.