From advocacy groups like HCAN and MoveOn.org to prominent blog sites like Daily Kos and Fire Dog Lake, single payer is the policy which must not be named. There seems to have been a strategic decision by several advocacy groups and progressive bloggers not to have a policy discussion or front page reporting relevant to Medicare for All once the policy was proclaimed "off the table" by the Democratic leadership and the President.

People and groups from Helen Thomas, George McGovern, Marcia Angell, PNHP, 1payer.net, NOW, California Nurses Association, Representative Weiner, and Mad as Hell Doctors, etc., have had their arguments against the current proposals being bandied about by Congress, and for single payer, either outright ignored, or marginalized to fit the advocacy for the so-called "public option". This has been a strategic blunder for the "public option" advocates.

What harm "public option" advocates see in reporting on or discussing more ambitious policy ideas, like Medicare for All or single payer, I have no idea. But eventually "public option" advocates need to rethink their failing strategy. In Congress thus far, we’ve seen the so-called "public option" reduced to what looks like a small safety net program practically designed to fail. What was once to be a robust Medicare-like insurance option open to all takers, now has CBO estimates of 10 million by 2019(under the best version from HR3200) or zero by 2019 from HELP.

The difficulty in arguing for something as amorphous as the so-called "public option" is it is unclear what the policy is, who should support it and why. Is it a mechanism to "keep insurers honest" as President Obama likes to say, or is it a viable alternative to private insurance, as the "public option" advocates maintain? Is it a national program open to all takers as "public option" advocates argue it should be or is just a "sliver" of private insurance reform, as President Obama contends it will be?

The problem the "public option" advocates have created in dismissing Medicare for All as politically infeasible is that they have not educated the public on either the benefits of public insurance or even what public insurance with a large market position could and would look like. In their silence, other media sources are busily defining Medicare for All in the most unhelpful terms. When "public option" advocates say "this was the compromise from single payer" they assume Americans know and understand what single payer is. They don’t. Therefor, not only is it hard for the public to appreciate the compromise, but it doesn’t form a basis of understanding amongst regular Americans of what public insurance looks like or what it can achieve.

Via Madison.com:

But while they blame the giant health care industry and Washington politicians, local health care reformers admit there is another contributing diagnosis for what ails the single-payer health plan. Even after – or perhaps because of – months and months of debate, many people in Wisconsin and across the country still don’t know what the heck a single-payer plan even is.

Minutes before the Mad as Hell rally, an informal survey of the crowd around the Capitol found many were at a loss to describe their understanding of a single-payer system, including some of the people who said they support it.

"I would think that it should come covering everything, basically," said one young Madison resident who chuckled when he realized he had not provided a very clear answer. "I’m not really sure, to be honest."

Another Madison resident paused for several seconds as he gave a halting explanation of what he felt the plan meant. "I think it’s … it’s one payer for everything," he said. "I think the payer is … part of the taxes. I’m here to encourage this to happen."

Robert Kraig, program director for Citizen Action of Wisconsin, says these Madison residents are not the only ones confused by the current debate. "People just don’t get this," he says. "It’s a very abstract concept. It’s something that’s understood by a well-educated group of progressive activists. But the problem is that the average voter has no idea what the words ‘single payer’ mean."

Marcia Riquelme, a grandmother and a local organizer with the Dane Grassroots Network who has fought for single-payer coverage full time since 2008, agrees: "A lot of peoples’ lives are too busy and hectic to have time to figure out what this all means."

As a result, she says, some people end up falling for conservative "lies and distortions" that the single-payer plan is nothing more than socialized medicine, and will lead to "death panels" and rationed care.

The Mad as Hell doctors offered local activists a prescription. "To win the war and the argument at the water cooler, it is important that everybody here have clear in their minds what single payer is," Adam Klugman, the group’s national creative director, said during a forum at First Unitarian Society.

Klugman said the Oregon doctors had come up with a one-sentence definition, which he asked the audience to memorize: "A system of payment that redirects all current health care monies, both public and private, into a single public fund that covers everyone."

Despite the public’s ignorance on single payer, most Americans favor it, suggesting that many if not most of the public are not happy with the insurance they have.

For those who think a "public option" is the only politically feasible step toward single payer health care, or at least that it can dramatically reduce the power of the private insurers, by not having that debate in the larger context of what Medicare for All can do, they lose valuable talking points on the virtues of public insurance(for instance that it can save over 350 billion a year, or that it can stimulate the economy), and thus they make the ever reducing role of the "public option" easier for legislators to exploit.

What’s happened here is what started out as a policy based on a large public insurance role for the government, has become a policy based on a small regulatory role over private insurers for the feds, with a possible public option as threat to private insurers, rather than a viable alternative in it’s own right. We can not have this conversation in a vacuum. Public option advocates will not prevail with a massive expansion of public insurance if they do not put their so-called compromise position in context the public can understand.

Even if we did not implement a single payer system, the principles single payer brings to the table in the health reform debate could lead to a more aggressive approach to reforming the health care system, rather than the current Romney Care role Congress is currently crafting. If we are not proposing a massive expansion of public insurance, than we must attain the most stringent regulations of private insurers. It’s not enough to count pledges on the so-called "public option" when the value of the "public option" being written in Congress is indeterminate.

Public option advocates need to reassess where they are and how to proceed. They need to acknowledge the short comings of their advocacy strategy and work to improve it. This approach not only alienates the strongest advocates of health care reforms, single payer proponents, it short changes the public debate over the role of public health insurance, and leaves legislators free to claim victory in passing the most meager of the ever shrinking "public option" proposals.

As Representative Weiner recently said, it appears the "the last thing we want to do is policy discussion", but at some point before health reform is declared done, we really ought to: