'Public option' becomes central to health debate

'Public option' becomes central to health debate (AP)
FILE -- In this May 11, 2009 file photo, Elizabeth Edwards is interviewed on the NBC "Today" television program in New York. (AP Photo/Richard Drew, File)

(AP) -- The idea of a government medical plan to compete with private insurance has become a litmus test in the health care debate. It could easily have been nothing more than a forgotten proposal gathering dust on some professor's bookshelf.

The "public option" followed an unlikely path to center stage in national politics. It started out with two liberal policy experts, working independently on different approaches. Along the way, Elizabeth Edwards - sensitized by her own experiences as a cancer patient - helped propel it into the presidential debate during her husband's campaign.

Now it's become the dividing line. Most Democrats insist any legislation must include the choice of federal coverage, while nearly all Republicans view it as a step toward a government takeover. President , eager to get a bill that can pass Congress, seems to be squirming in the middle.

A look at the roots of the idea shows that the policy experts who proposed early versions believed the federal plan would eventually become one of the largest insurers in the country - a major expansion of the government's role.

But Obama and other candidates saw the idea through a political lens, a compromise between rival Democratic factions. One side wants Medicare-for-all, while the other prefers to subsidize coverage through private insurance plans - as Massachusetts has done. The debate within the party still rages, with Obama in the crossfire.

Former North Carolina Sen. John Edwards was the first Democratic presidential candidate to propose a public option as part of his health care plan, unveiled in 2007. Behind the scenes, his wife, Elizabeth, was a strong advocate.

In an interview, Elizabeth Edwards said that as the daughter of a Navy captain, she grew up with government health care and found it dependable. Later in life, her sojourn in the medical world as a patient opened her eyes to the travails of people who had no insurance, or whose coverage turned out to be unreliable.

"I met people who were constantly coming up against one problem or another," Edwards said. "Even people like me, who have health care, know someone who has been through some misery because they couldn't afford the health care they needed."

Before the 2008 presidential campaign, chances were slim that lawmakers one day would consider government coverage for middle-class workers and their families. Liberals had talked for years about expanding Medicare to cover not just seniors, but all Americans. That's all it seemed to be - talk.

Political scientist Jacob Hacker had proposed a plan in 2001 that he called "Medicare Plus." Employers could choose either to offer private insurance or pay a payroll tax to finance coverage for their employees through a health plan modeled on Medicare. Early in 2007, as the presidential campaign was gearing up, Hacker retooled his proposal. It quickly caught on with core Democratic constituencies.

"The unions fell in love with Jacob's idea," said health economist Len Nichols of the New America Foundation.

Hacker, now at Yale University, said he wanted to bridge the gap between Democrats who supported a single payer plan like Medicare-for-all and those who wanted to preserve the employer coverage that has served most Americans for a half century.

"I tried to provide a case for seeing common ground between those two positions," Hacker said. "There's certainly a strong political argument that single payer is not feasible. Threatening (employer) coverage is a political nonstarter, and moving all health care spending onto the public budget is virtually impossible in the current fiscal climate."

Estimates showed his public plan would end up covering about half of workers and their families - giving the government a powerful position in the market.

On the other side of the country, a Berkeley health policy professor had already come up with the idea of a head-to-head competition in which individuals would choose between a government plan and private plans. Helen Halpin proposed such a scheme in 2002 for California, and the following year she retooled it as a national proposal.

Called the CHOICE Option, Halpin's plan amounted to a referendum on whether government coverage or a private plan is better. It's close to the spirit of what Democrats are now proposing.

"May the best model win," Halpin said. "Depending on the preferences of the population, the system could evolve to single payer, but it would be a totally voluntary transition." Her bet: The government plan wins.

Edwards' health care adviser, Peter Harbage, said he was familiar with both Halpin's idea and Hacker's proposal, and they were discussed in the campaign's deliberations.

"What Helen had here was the idea of choice, and choice as an option," said Harbage, now at the Center for American Progress. "The catch phrases people are using today were part of her paper."

Edwards decided on his plan after the campaign set up a private teleconference debate that featured two independent policy experts. One argued for a government-run system, while the other defended a market-based approach like Massachusetts has.

"We were both walking around with phones," said Elizabeth Edwards. "I was listening in." After the debate, her husband decided to go for the market-based approach - with a public option added.

Later on, Obama and Hillary Rodham Clinton adopted the public plan. It wasn't controversial in the Democratic primaries, and Republican John McCain did not make a major issue of it in the general election.

Halpin went on to serve as a health policy adviser to the Obama campaign, where she worked on the public plan. She's since returned to academia. Hacker remains a leading spokesman for the idea.

The idea remains popular with the public: A Kaiser Family Foundation poll this week found 59 percent of Americans support it.

©2009 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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User comments

Aug 22, 2009
How many people over the age of 65 can AFFORD the inflated rates charged by insurance companies for coverage to persons over the age of 65, Mr Park?

Most seniors struggle to pay for their supplementary coverage(private insurance) which pays their Medicare deductibles, copays, and other out-of-pockets.

If private insurance is so lovely, why would anyone in their right mind join a public plan?

Private insurance is in the business of making a profit. This means that the average insured is constantly being denied, precluded, and excluded from coverage, or cannot obtain needed treatment modalities due to non-coverage by their wonderful private insuror. I know, because I was employed in the healthcare industry for nearly 20 years.

If you follow the news through any other source than Newscorp., perhaps you may have gotten word that the push is currently on in the insurance biz to intitute a 35 percent cost-shift to consumers, instead of the roughly 20% now common practice. What this means is that the insurance companies will keep 35% of the gross, and pass the "savings" on to the policy holders- which is to say- still higher premiums, still larger deductibles, copays, out-of-pockets -still more procedures, treatments, devices denied, and still more people uninsured because they can't afford the premiums.

I recommend that you pull your head out of your ass and get with the program.

Aug 22, 2009
Eventually everyone is going to have to come to terms with the fact that, in the end--no matter how good a doctor they have, or how great their insurance plan is--they are going to DIE.

All the medical industry does is prolong the inevitable--hopefully along the way they make things easier(less painful)--but they have never permanantly SAVED even one life.

Aug 22, 2009
Jerry, your statement: "you are likely to need care and have it denied if we get national health care." doesn't make sense. Think about it.

Aug 23, 2009
While your credentials carry no more weight than mine, JP, it is easy to see that you have adopted the conservative denier attitude, which leads me to believe that you are most likely in the position of receiving payment for the services you provide.
People in that position get pretty uptight when they think that their paycheck is threatened, and forget that medecine is for the benefit of the patient- and not everyone should feel entitled to a mercedes and two or three vacation homes just because they chose healthcare as a career. It doesn't matter if payment comes from the government or from private insurers- the only real difference is that the public option provides for all or nearly all to be covered, and will still be about 90-95% contributory(paid for by insured) as opposed to an entitlement program. All that this "controversy" boils down to is that private insurors(and their investors) will see a large decrease in easy money in the form of quarterly profits and dividends. It is a real shame that so many people in this country put private gain for themselves ahead of the most basic consideration for their fellow men.

Aug 23, 2009
Maybe one can look to other countries (e.g. in Europe). There private and public insurers live happily side by side (and have done so for nearly half a century in some countries). No reason to suspect one is going to push out the other.

Private companies charge more and offer perks (single rooms in hospitals, payment on 'non-necessary' surgery and whatnot). They are also mandatory for people who are self-employed.

If you need the perks you pay - if you don't then no procedure is denied to you anyways. Works well and doesn't cost an arm and a leg.

Aug 30, 2009
Boy, this sure does get tiresome. Your last posted comment, as well as those previous, is spurious, disengenuous chicanery. Your corporate masters have trained you well, as evidenced by your slavish pounding of Talking Points, rather than rational discourse. The Public Option is COVERAGE PAID FOR BY THE INSURED, ADMINISTERD BY THE FEDERAL GOVERNMENT, AVAILABLE ON A VOLUNTARY BASIS FOR THOSE WHO CANNOT AFFORD OR ARE DENIED PRIVATE INSURANCE.
If you don't want a public option, then get Private for-profit insurance companies to provide universal, affordable, non-exclusionary insurance for ALL AMERICANS.

Aug 30, 2009
It is interesting that people sit at keyboards in the world's only super power, courtesy of our military (a government issued, GI, service), and say the government can't do anything right.

Also, if you check the list of the 100 best hospitals (USN&WR) in the USA, you'll note that they are non-profits, often associated with public universities (government provided institutions).

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