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Sam Stein Headshot

Did Obama Campaign On The Public Option? Yes But Not Entirely

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President Barack Obama, in an interview with The Washington Post, said on Tuesday that in the two years leading up to his election he "didn't campaign on the public option" for insurance coverage.

Could that possibly be true? A plan for government-run insurance has been the focal point of the soon-to-be-concluded health care debate; the catalyst of white-hot partisan warfare; and the provision that progressive and conservatives alike have deemed the arbiter of whether legislation is a success. Is it possible the political world was, by-and-large, confused when they assumed this was what candidate Obama had wanted?

Not entirely.

The Obama campaign clearly did incorporate the public option into its health care agenda. The then-candidate signed a statement put together by the pro-reform group Health Care for America Now, which included the provision as part of its principles for reform. On issue forms Obama filled out for several publications he pledged to "create a new public health plan for those currently without coverage." His campaign arm, Organizing for America, continues to champion a "public health insurance option to provide the uninsured and those who can't find affordable coverage with a real choice." The White House website says that: "The President believes [public health insurance option] will promote competition, hold insurance companies accountable and assure affordable choices. It is completely voluntary."

It does, indeed, seem fair to say that a public option for insurance coverage was a component of the Obama health care agenda. But exactly how serious a component was it?

An examination of approximately 200 newspaper articles from the campaign, as well as debate transcripts and public speeches shows that Obama spoke remarkably infrequently about creating a government-run insurance program. Indeed, when he initially outlined his health care proposals during a speech before the University of Iowa on March 29, 2007, he described setting up a system that resembles the current Senate compromise - in which private insurers would operate in a non-profit entity that was regulated heavily by a government entity.

"Everyone will be able buy into a new health insurance plan that's similar to the one that every federal employee - from a postal worker in Iowa to a Congressman in Washington - currently has for themselves," Obama said at the time.

In the following months, reporters would remark, as did Robert Pear of the New York Times, that Obama "says he would 'establish a new public insurance program' for people who do not have access to group coverage." But it's not clear that their reference was a non-profit entity modeled after congressional coverage or the "government-run plan" that progressives pine for today.

By December 2007, however, Obama clearly had endorsed a government-run option. In a speech at the Iowa Heartland Presidential Forum, the then-Senator declared that if he "were designing a system from scratch" he would "probably move more in the direction of a single-payer plan,"

"But what we have to do right now," Obama added, "is I want to move to make sure that everybody has got coverage as quickly as possible. And I believe that what that means is we expand SCHIP. It means that we extend eligibility for some of the government programs that we have. We set up a government program, as I've described, that everybody can buy into and you can't be excluded because of a pre-existing condition."

In January 2008, meanwhile, Obama submitted an issue form to Ebony Magazine, in which, as the third principle of his health care reform agenda, he promised to "require all employers to contribute toward health coverage for their employees or toward the cost of the public plan."

By that point, the press, commentariat and widely respected health care observers all were reporting the government-run plan as a component of the Obama agenda.

On May 31, 2007, Atul Gawande, a surgeon at Brigham and Women's Hospital in Boston and a New Yorker staff writer, wrote in The New York Times that both Obama and then-candidate John Edwards, were offering "a choice of competing private plans, and... a Medicare-like public option, too."

On September 20, 2007, Ezra Klein -- then a staff writer at The American Prospect and now with The Washington Post -- wrote a column for the Los Angeles Times in which he said that "all of the Democrats" in the primary field had offered the option of "a government-run insurance program modeled on, but distinct from, Medicare."

On February 12, 2008, Jonathan Oberlander of the University of North Carolina, told NPR's Fresh Air that Obama and then-Sen. Hillary Clinton both "would create a new public plan similar to Medicare."

"And do we have any sense of what those public plans would look like?" the host asked.

"They have been fairly vague about that, as candidates often are in this election season, other than to say it would be like Medicare," said Oberlander.

On February 26, 2008, meanwhile, Jacob Hacker, the so-called "godfather" of the public option, offered much the same synopsis. In an editorial in the Los Angeles Times, the Yale University professor noted that both Clinton and Obama would require employers to "provide coverage to their workers or enroll them in a new, publicly overseen insurance pool." People in this pool, he added, "could choose either a public plan modeled after Medicare or from regulated private plans."

On July 30, 2008, The New Republic's Jonathan Cohn wrote that Obama was gravitating closer and closer to making the public plan a prominent feature of his health care platform. "[He] not only included an optional public plan in his eventual blueprint for universal coverage; more recently, he also tapped Hacker to be on his campaign's health care advisory committee," Cohn wrote.

On August 18, 2008, Cohn followed up on his story, writing that Heather Higginbottom, the Obama campaign's policy director and now White House adviser, considered the public plan "an elemental pillar" of the proposal. The President, Cohn added (channeling Higginbottom) "is prepared to defend this fall even if, as expected, Republicans attack it (falsely) as a "government takeover" of medicine."

The general press, naturally, followed suit.

Fortune Magazine, on July 7, 2008, wrote that "At the center of Obama's plan to help ease the middle-class crunch would be a requirement that nearly all businesses provide health insurance or contribute to a government-backed "purchasing pool" that includes private plans and one public plan like Medicare."

The Chicago Tribune, on August 21, 2008, wrote that Obama, "would require employers to offer health benefits to workers or contribute to the cost of a new public plan"

The National Journal on August 23, 2008, reported that Obama's health care plan "would require insurance companies to compete in publicly structured exchanges not only with each other but also with a government-run insurance plan. 'Wherever possible," Obama said in an interview last year, he wants to harness "market mechanisms to bring about change.'"

There are countless other examples as well; but remarkably few other times in which Obama himself was quoted supporting an additional program of government run insurance. His campaign never pushed back on the report. If anything, it seems they clearly constructed a health care strategy that embraced the public option as one of several principles of reform.

It also, however, seems clear that the philosophical attachment of the candidate to the issue was limited. Obama would discuss the public option more frequently once he took office. But on the trail he almost always highlighted other elements of his health care agenda first. As one progressive activist who has worked on health care reform for the past year put it:

"What I think [Obama's] point was [in making his statement to the Washington Post], is true. The public option was not his number one talking point on the trail. Hell, it wasn't even number 12. The public option didn't become the central part of health care reform until after [he entered the White House]."