http://www.prospect.org/csnc/blogs/tapped_archive?month=08&year=2009&base_name=the_history_of_the_public_opti"...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:
....
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?"
Campaign for America's Future Blog Chronicles Impact of Hacker Health Care for America Plan on the Evolution of the Edwards and Obama Health Proposals
Health Care for AmericaBy Roger Hickey on January 11, 2007 - 4:14pm.29 page pdf - including the endorsements of the original Hacker plan
http://www.ourfuture.org/files/documents/evolution-of-the-healthcare-debate.pdf"The great debate over how to fundamentally fix our broken health care system just got a lot more interesting.
Today, the Economic Policy Institute released the Health Care for America plan – a simple yet sophisticated approach crafted by Jacob Hacker, author of “The Great Risk Shift.” Health Care for America, which you can find at www.sharedprosperity.org, comprehensively tackles the major health care problems holding back our society and economy: the 46 million uninsured, the skyrocketing costs and the uneven quality.
My organization, Campaign for America’s Future, will be launching a nationwide effort to discuss and debate how to get good healthcare coverage for all Americans while controlling spiraling health care costs. The best way to start that debate is to put a simple, clear and progressive health care plan on the table. Health Care for America is that plan, and it will be a benchmark by which all other plans can be judged.
How? By creating a Medicare-style system for all Americans under 65. The uninsured and underinsured could buy into the Health Care for America plan, with federal or state government assistance if necessary. Medicare and Health Care for America would then join forces and wield enormous bargaining power, driving down costs and raising the bar on quality..."
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