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THE HISTORY OF THE PUBLIC OPTION.
As progressives mourn the likely death of a public insurance option in health care reform, it's worthwhile to trace the history of exactly where this idea -- a compromise itself -- came from. The public option was part of a carefully thought out and deliberately funded effort to put all the pieces in place for health reform before the 2008 election -- a brilliant experiment, but one that at this particular moment, looks like it might turn out badly. (Which is not the same as saying it was a mistake.)
One key player was Roger Hickey of the Campaign for America's Future. Hickey took UC Berkley health care expert Jacob Hacker's idea for "a new public insurance pool modeled after Medicare" and went around to the community of single-payer advocates, making the case that this limited "public option" was the best they could hope for. Ideally, it would someday magically turn into single-payer. And then Hickey went to all the presidential candidates, acknowledging that politically, they couldn't support single-payer, but that the "public option" would attract a real progressive constituency. Here's Hickey from a speech to New Jersey Citizen Action in November 2007:
The good news is that people are ready for big change. But the hard reality, from the point of view of all of us who understand the efficiency and simplicity of a single-payer system, is that our pollsters unanimously tell us that large numbers of Americans are not willing to give up the good private insurance they now have in order to be put into one big health plan run by the government.Pollster Celinda Lake looked at public backing for a single-payer plan - and then compared it with an approach that offers a choice between highly regulated private insurance and a public plan like Medicare. This alternative, called "guaranteed choice" wins 64 percent support to 22 percent for single-payer. And even the hard core progressive part of the population, which Celinda calls the "health justice" constituency, favors "guaranteed choice" over single-payer. ...
Starting in January, we began to take Jacob Hacker to see the presidential candidates. We started with John Edwards and his advisers -- who quickly understood the value of Hacker's public plan, and when he announced his health proposal on "Meet The Press," he was very clear that his public plan could become the dominant part of his new health care program, if enough people choose it.
The rest is history. Following Edwards' lead, Barack Obama and Hillary Clinton picked up on the public option compromise. So what we have is Jacob Hacker's policy idea, but largely Hickey and Health Care for America Now's political strategy. It was a real high-wire act -- to convince the single-payer advocates, who were the only engaged health care constituency on the left, that they could live with the public option as a kind of stealth single-payer, thus transferring their energy and enthusiasm to this alternative. It had a very positive political effect: It got all the candidates except Kucinich onto basically the same health reform structure, unlike in 1992, when every Democrat had his or her own gimmick. And the public option/insurance exchange structure was ambitious.
But the downside is that the political process turns out to be as resistant to stealth single-payer as it is to plain-old single-payer. If there is a public plan, it certainly won't be the kind of deal that could "become the dominant player." So now this energetic, well-funded group of progressives is fired up to defend something fairly complex and not necessarily essential to health reform. (Or, put another way, there are plenty of bad versions of a public plan.) The symbolic intensity is hard for others to understand. But the intensity is understandable if you recognize that this is what they gave up single-payer for, so they want to win at least that much.
The alternative history question would be: What if they had pushed for single-payer all along? Could the political process then have sold them out and compromised by supporting the public option we now look likely to lose?
--Mark Schmitt
COMMENTS (13)
Oh, hell! Progessives did this to us?
What was wrong with calling for Medicare for All?
(I would pound my head on the desk but I can't risk needing health care.... Thanks a lot, dudes.)
Posted by: jawbone | August 18, 2009 11:16 AM
"Guaranteed Choice"? Now that sounds like a nice market-tested term! How come we're talking about the sterile "public option" and not "guaranteed choice"?
Posted by: pain perdu | August 18, 2009 12:16 PM
I'm astonished to see how consistently we've ignored the lessons of history, which tell us exactly how to create a national health service even with a balance-of-trade and public debt problem far worse than ours. How about a little trip back in time, to 1948?
http://www.nationalarchives.gov.uk/cabinetpapers/themes/creation-national-health-service.htm
Posted by: Doug Bostrom | August 18, 2009 7:38 PM
"How about a little trip back in time, to 1948?"
Eric Arthur Blair once said the title of his iconic book was not meant to evoke some far-off future time, but to make people think of the present - byu using an anagram for the year the book was written - 1948.
Blair's pen name of course was George Orwell.
Posted by: John Fembup | August 19, 2009 11:38 AM
"How about a little trip back in time, to 1948?"
Eric Arthur Blair once said the title of his iconic book was not meant to evoke some far-off future time, but to make people think of the present - byu using an anagram for the year the book was written - 1948.
Blair's pen name of course was George Orwell.
Posted by: John Fembup | August 19, 2009 11:39 AM
The confession that the public option is merely a stealth verison of universal, government run health care is helpful. Thank you. Please tell President Obama to correct his talking points. He should stop saying that the public option won't affect your or my existing health care because it's clear from your posting that's just what it's intended to do.
Posted by: DBL | August 19, 2009 1:55 PM
Thanks so much. The problem with speaking with many of my less informed democratic friends about this awful piece of legislation is explaining that, once gov't option is available, there WILL BE NO EMPLOYER OPTION.
My liberal demo buddies have been very honest about this. I honestly disagree with universal health, single payer, etc. and am tired of hearing this "option" line.
They think I don't understand. I do understand, I am a registered independent, and like the majority of the country, I disagree.
Hilarycare brought us Newt Gingrich, and I'm hoping this generation of dems has the sense to get off that bus to minoritydom.
Posted by: Andie | August 19, 2009 3:57 PM
So, you are saying Obama is lying, as conservatives have been saying all along? I"m shocked, shocked!!
Posted by: Anonymous | August 19, 2009 5:15 PM
Surprise! Sometimes you can overestimate the density of the American voter.
Posted by: soljerblue | August 19, 2009 7:03 PM
It is clear that Andie and DBL have a reading comprehension problem. As you mentioned in the article Mark, (though it could have used more elaboration) even the strongest version of the public option in any of the bills is far too small to make a dent on the health insurance scene.
10 million in the public option is the number.
The rest of Americans who aren't old enough to be on Medicare or poor enough to be on Medicaid (which equals about 150-200 million Americans) will be locked into junk insurance, where we pay ever increasing and insufficiently regulated premiums, co-pays and drug prices only to be denied/delayed health care when we actually need it to heal our suffering and save our lives.
Almost 200 million Americans we won't have the option of "the public option" they'll be mandated to buy junk insurance. Why isn't this the headline in every liberal publication and blog???
I don't have a problem with mandate; I have a problem with mandates to buy junk insurance. A mandate with the option to buy into Medicare is fair. This is just taking Roomney-care national. Who knew that by electing Barack Obama we'd be getting Mitt Romney. This is exactly what he did in Mass. and it's led to the middle-class being hosed with increases in out-of-pocket costs far greater than would be without a mandate to buy junk insurance.
So I am clear, I am a Medicare for All person, and entirely agree that if we started there we'd probably at least be getting Medicare for Those Who Want It this go 'round. My issue with the public option is that it is no where near as broad and open to everyone as to make it effective, as thought by the stupid conservatives who are too dumb to realize that their getting screwed by the health insurance hit men as the rest of us.
Posted by: DWCG | August 20, 2009 12:39 AM
I see, so when you can't persuade the public through honest dialogue you resort to trickery and subterfuge? Is that your idea of showing respect to citizens? Sounds more like power hungry thugs intent on getting their own way at any cost.
Posted by: Jeff | August 20, 2009 7:32 AM
What Obama needs to do is to just say "I'm sorry". Not get defensive. Not try to explain it away. Not give half-apologies like "I regret if anyone was offended", because that imputes blame on the insulted party for feeling insulted.
Posted by: Lingerie | August 30, 2009 10:31 PM
This is just taking Roomney-care national. Who knew that by electing Barack Obama we'd be getting Mitt Romney. This is exactly what he did in Mass. and it's led to the middle-class being hosed with increases in out-of-pocket costs far greater than would be without a mandate to buy junk insurance.
Posted by: Stainless Steel Pipe | November 18, 2009 9:41 PM