There can be no compromise on the Public Option.

As I have said repeatedly before, I have not yet capitulated to the doomsaying that endlessly and pre-emptively declares the Public Option to be dead on arrival, and I think such declarations have no effect at all except to squander energies that are needed in the struggle to fight that very outcome.

But I am enough of a pragmatically-minded person with enough of a memory of serial disappointments from my elected representatives that I have returned over and over again to the healthcare reform debates to try discern in the various proposals and counter-proposals something that might still register as some kind of progress if indeed the Public Option fails to find its way (however nudged, fudged, or re-named) into legislation, some kind of silver lining in the face of catastrophic capitulation on the Public Option.

I have to admit I haven't been able to do it.

The White House and reform-minded Representatives have indicated time and time again what the problems are that need to be addressed, and I simply can’t figure out how it’s possible to accomplish even the most basic agreed-upon objectives of health care reform without the Public Option.

I mean, I know we all keep saying this over and over, but the Public Option was already the compromise we were forced to accept before negotiations even began when the incomparably better (and by "better" I mean: more moral, more efficient, clearer and hence easier to explain and sell) alternative of Single Payer was taken off the table.

I understood the reasoning behind that move (although it should have been plain to the meanest intelligence that opponents would call any real reform at all "socialist" and "fascist" and all the rest, whatever the facts are), but it definitely had the consequence of eliminating most of the wiggle-room available to any real reform effort, which is almost never a good idea.

And I have to say how flabbergastingly not acceptable any guarantee of universality through "individual mandates" is as a "next compromise" after pre-emptive capitulation on Single Payer (say, simply extending Medicare to all citizens) and then a second capitulation on the Public Option as well.

The Public Option guarantees universality quite simply through being available to all -- should they choose it. And then it functions to keep even those who do not choose it -- because they like the coverage they have already, or at any rate think that they do for now -- safer from the worst excesses of the present catastrophic for-profit system simply through the force of competitive pressures.

Achieving universal coverage instead through the expedient of so-called "individual mandates," that is, forcing everybody by law to buy crappy private insurance from crappy profit-motivated insurance companies that everybody knows are the actual villains in this story, is the worst imaginable outcome here.

Who in their right mind would describe as "reform" an outcome in which the police took the side of the highway robber with a gun at your head?

Individual mandates provide no check on the inefficiencies of for-profit healthcare, all the idiotic marketing costs, the endless middle-men, the incentives for needless procedures.

As the price of healthcare continues to rise as it obviously will without the creation of any real checks on the structural conditions presently driving this hyper-inflation of costs, how will America cope with all of those personal bankruptcies and failed businesses that will inevitably continue and accelerate as insurance companies continue to exploit personal disaster as the occasion for ever more ruinous profit-taking?

How is America supposed to "compete" (to speak the idiotic language forced on us by every side of this debate apparently) with countries that have none of these problems because they have saner healthcare systems? Obama has made these arguments himself, but how does he hope to address them without the Public Option?

And then there are, of course, all the heartbreaking and enraging stories we have all heard and most of us have lived with in some measure by now -- stories of outrageous death-dealing denials of care -- stories of vulnerable citizens shuffled off at ruinous pointless public cost to already catastrophically overburdened Emergency rooms when long-neglected conditions easily and cheaply treated at earlier stages become costly often lethal crises -- stories of countless lives frozen in place, opportunities curtailed by fears of dropped coverage -- stories of for-profit insurance company "death panels" rationing care through denials and through delays based not on providing care but improving their bottom lines and securing their obscene bonuses.

Some progressive folks are clinging rather desperately to the notion that regulations banning denials of care based on "pre-existing conditions" and so on will at least do some good -- and I have tried to find some way of doing the same myself. But I have to ask the brutal question: In the absence of a Public Option and the competitive pressures it introduces into the terrain, what exactly is supposed to be the enforcement mechanism for such bans?

The heartless bastards who run for-profit insurance companies will just find new names for the same immoral practices, new "provision instruments" that circumvent the letter of the law. No lawmaker can anticipate the endless inventiveness of cunning opportunistic for-profit hucksters coming up with new ways to cut corners and defraud the public on a day to day basis in search of short-term profit whatever their consequences to individual lives or the life of the Republic. If this weren't true, the problems health care reform are seeking to address would not exist.

If anything, these gangsters will have been emboldened to do their worst by the fact that a President elected with an explicit mandate to deliver quality healthcare for all Americans supported by majorities in both the House and Senate and the overwhelming support of the American people for that very policy was able in the end to do nothing but force all Americans to give their treasure to the villains who would take their lives, without addressing any of the actual problems that everybody agrees we must address if the American experiment is to have any kind of chance at all to succeed for the next generation.

There can be no compromise on the Public Option.