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Public Option's Architect Intrigued By Medicare Buy-ln: 'The Original Idea'

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The intellectual father of the public option expressed enthusiasm on Wednesday for the decision by Democrats to push for an expansion of Medicare coverage to consumers as young as 55, calling it the "original idea" behind the public plan.

Jacob Hacker, a Yale University professor and leading health care theorist, did not fully endorse the latest incarnation of reform making its way through the Senate. Indeed, he was critical of some of the policy negotiations, in particular the decision to replace an actual public option with something run by private insurers and regulated by the government -- which he deemed "inadequate" and incompatible with the president's principles of reform.

But in a segment on PBS's Newshour, Hacker did call the proposed expansion of Medicare an "enormous, positive development." And, in the process, he provided Senate Democrats with at least a modicum of intellectual cover as they try to patch together their final reform effort.

Well it certainly is a broad compromise, but I think it's a complex one. It has a lot of moving parts and a lot of details we don't know yet.

The way I would describe it is, in sort of Dickensian terms, is it's a tale of two public options. Public option one, the public option that was going to be within the exchange and available to Americans on day one to create competition for private insurance plans to give people a choice, that public option has been replaced, in my mind, with an inadequate substitute, a national system of private plans.

But public option two, which was never on the agenda before, a buy-in to the actual Medicare program for 55- to 64-year-olds, is an enormous positive development. It's actually the original idea, if you will, for the public option, simply letting people get into the Medicare program that provides broad, secure coverage at an affordable price.

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It's worth noting that one of the provisions Hacker liked about the revised Senate effort was its immediacy. The Yale professor said that having the Medicare buy-in start as early as 2011 -- which appears to be the goal of Senate Democrats -- would be a major breakthrough, something "that is concrete, that people will be able to see it changing lives very early in the reform process." He also stressed that if the Senate drops the public option from its legislative language, it needs to ensure that strong regulatory incentives (triggers) are put in place to keep private insurers in check.

So, I'm strongly of the view that the way to strengthen this would be to say, look, OK, Office of Personnel -- and I just say and just want to say the insurance companies clearly think that this was a big win for them. There was an insurance industry insider who just wrote on a blog, "We win, administered by private insurance companies, no government funding."

Well, if they have won this round, the question is, can we put in place a trigger that says, if they don't perform up to expectations, then, in the next round, there's a public option that isn't restricted to people over the -- over 55?

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