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Godfather of the public option: Pass the Senate bill

Jacob Hacker, who's often called "the Godfather of the public option," weighs in on the Senate bill:

Since the first campaign for publicly guaranteed health insurance in the early twentieth century, opportunities for serious health reform have come only rarely and fleetingly. If this opportunity passes, it will be very long before the chance arrives again. Many Americans will be gravely hurt by the delay. The most progressive president of my generation -- the generation that came of age in the anti-government shadow of Ronald Reagan -- will be handed a crippling loss. The party he leads will be branded as unable to govern.

The public option was always a means to an end: real competition for insurers, an alternative for consumers to existing private plans that does not deny needed care or shift risks onto the vulnerable, the ability to provide affordable coverage over time. I thought it was the best means within our political grasp. It lay just beyond that grasp. Yet its demise -- in this round -- does not diminish the immediate necessity of those larger aims. And even without the public option, the bill that Congress passes and the President signs could move us substantially toward those goals.

As weak as it is in numerous areas, the Senate bill contains three vital reforms. First, it creates a new framework, the “exchange,” through which people who lack secure workplace coverage can obtain the same kind of group health insurance that workers in large companies take for granted. Second, it makes available hundreds of billions in federal help to allow people to buy coverage through the exchanges and through an expanded Medicaid program. Third, it places new regulations on private insurers that, if properly enforced, will reduce insurers’ ability to discriminate against the sick and to undermine the health security of Americans.

These are signal achievements, and they all would have been politically unthinkable just a few years ago.

By Ezra Klein  |  December 21, 2009; 9:30 AM ET
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Next: Jon Kingsdale reflects on three years of health-care reform


Now the "progressives" will vilify him too. It's too bad we have to put quotes around progressives these days, I personally have never stopped calling myself liberal.

Posted by: LiberalForReal | December 21, 2009 9:49 AM | Report abuse

Perhaps the progressives who are disappointed in this bill should embrace it as "a new framework" which may not contain all of the reforms they wanted, but, once enacted, can be used as leverage for future tweaks and reforms.

Time to get over the "kill the bill" mentality and start planning how to improve our health care system as we go forward (I'm sure the Republicans are already planning how to weaken the reforms that are in this bill).

Posted by: tnoord | December 21, 2009 10:02 AM | Report abuse

"The public option was always a means to an end: real competition for insurers, an alternative for consumers to existing private plans that does not deny needed care or shift risks onto the vulnerable, the ability to provide affordable coverage over time."

The public option was always a misguided attempt to use "market forces" to reform health care financing. There is no successful universal health system that uses a public insurance company to do what Hacker describes...not one.

Any plan that protects people whose bills are paid by someone else is no reform at all.

Posted by: Athena_news | December 21, 2009 10:05 AM | Report abuse

It is notable how fundamentally dishonest the health care debate as become on all sides. The right wing have had their "death panels" and now the left wing has their attack dogs out about being stabbed in the back by the Obama administration, who they will claim to have singled handedly elected. They dishonor themselves and their cause.

This is another example of that dishonesty, this time from a liberal columnist. The illusions of creating your own expectations and projecting them on a political leader as if they were factually based are widespread. The public option was not at the center of health care debate in the campaign. Now they act as this proposal which would have covered 9% of Americans at best is the only policy initiative that matters. "Progressives" now trash the president accusing him of betrayal on Afghanistan and health care when he, in truth, has followed a policy pretty close to what he advocated in the campaign. As one who has thought of himself as "progressive" I am finding myself most disillusioned by those who call themselves "progressive" and who cover a host of sins with that label, a label that increasingly lacks any semblance of integrity.

Posted by: cmpnwtr | December 21, 2009 10:08 AM | Report abuse

What was he going to say? He justs wants any crappy bill to pass and call it a win. He, along with the other dems are going to find out the hard way how bad this bill is. Real progressives tried to warn them!

Posted by: obrier2 | December 21, 2009 10:10 AM | Report abuse

Top 10 Reasons to Kill Senate Health Care Bill

Forces you to pay up to 8% of your income to private insurance corporations — whether you want to or not
If you refuse to buy the insurance, you’ll have to pay penalties of up to 2% of your annual income to the IRS.
Many will be forced to buy poor-quality insurance they can’t afford to use, with $11,900 in annual out-of-pocket expenses over and above their annual premiums
Massive restriction on a woman’s right to choose, designed to trigger a challenge to Roe v. Wade in the Supreme Court
Paid for by taxes on the middle class insurance plan you have right now through your employer, causing them to cut back benefits and increase co-pays
Many of the taxes to pay for the bill start now, but most Americans won’t see any benefits — like an end to discrimination against those with preexisting conditions — until 2014 when the program begins.
Allows insurance companies to charge people who are older 300% more than others
Grants monopolies to drug companies that will keep generic versions of expensive biotech drugs from ever coming to market.
No re-importation of prescription drugs, which would save consumers $100 billion over 10 years
The cost of medical care will continue to rise, and insurance premiums for a family of four will rise an average of $1,000 a year — meaning in 10 years, your family’s insurance premium will be $10,000 more annually than it is right now.

Posted by: obrier2 | December 21, 2009 10:28 AM | Report abuse

Interestingly the top ten reasons to kill the bill are remarkably similar to the top ten things that will happen if we do nothing.

I think it will help everyone's perspective if we flash back to December 2004 and imagine someone predicting the passage of this bill in just 5 years time.....

Posted by: PhD9 | December 21, 2009 10:42 AM | Report abuse

“Health care in America ought to be a right, not a privilege,” said Senator Christopher J. Dodd, Democrat of Connecticut. “Since the time of Harry Truman, every Congress, Republican and Democrat, every president, Democrat and Republican, have at least thought about doing this. Some actually tried.”

Posted by: JetfireK | December 21, 2009 7:38 PM | Report abuse

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