“New Life for the Public Option” is the headline of Dan Balz’s excellent article in Sunday’s Washington Post. It’s not an accident that this powerful idea has made yet another comeback. And it is not surprising that public and Congressional support, always strong, has surged again, just as the insurance industry has ham-handedly tried to manipulate the choices of key decision-makers in the US Senate. In the crucial next few days – and in the weeks to come – advocates of the public option will be arguing that the principle of majority-rule democracy should be allowed to work. And the insurance and drug industries (and Republicans) will be basing their strategy for stopping the public plan on an undemocratic procedure called the filibuster.
The public option has been part of the national health care debate since January 2007, when the Economic Policy Institute published Jacob Hacker’s Health Care for America plan. From that moment to this, many in the media and the pundit class have periodically dismissed its chances. But that was also the moment that Hacker, Diane Archer and I started having discussions with three essential audiences: leaders of activist citizen organizations, Congressional leaders, and presidential candidates. (For a record of that early organizing, click here.) Our message: a public insurance option is crucial to the success of real reform in America’s mixed system of private and public health insurance – especially if our government agrees to the demand of insurance companies that all Americans must be forced to buy insurance.
Those early conversations and the primary election campaign debates produced a consensus in favor of a public option, as first candidate John Edwards (in February 2007), then Barack Obama (in May), and (in September) Hillary Clinton all came forward with health reform plans based primarily on preserving employment-based health insurance for those who have it and reforming and expanding private health insurance for those who don’t. And all three Democratic presidential candidates called for a public insurance plan, like Medicare, that would give Americans choices – and give the private insurance companies real competition that could control health care premiums.
Even though some progressives were committed to a pure single-payer plan, leaders of many of the major organizations representing millions of Americans – unions, community networks, civil rights groups and health advocates – realized that private insurance companies would not soon be put out of business. Drawing on Hacker’s work, these groups came together around a plan for reforming the worst practices of the insurance companies, requiring all but the smallest firms to cover their employees, guaranteeing affordable coverage to everyone through an insurance exchange, and offering a public insurance option as one of many choices in the exchange. The Health Care for America Now! coalition, now representing 1,000 citizen organizations and millions of people, was built around these principles – and HCAN has consistently insisted that if you take away one part of the plan – whether it is affordable coverage, insurance reform, or the public option – and the whole enterprise of building reform on a mixed system might just collapse and end up throwing money at the insurance and drug companies without achieving real reform or universal coverage.
HCAN also formalized outreach to Members of Congress and candidates for House and Senate in the buildup to the 2008 elections – though thousands of town meetings and local accountability sessions. By the time of the election, over half of the new Congress had publicly embraced the HCAN health reform principles. And two candidates for executive office, Obama and Biden had also signed on to those principles. The growing support for the public option in Congress reflects HCAN’s steady and creative organizing – writing the new textbook for a citizen majority overcoming some of the most powerful special interests in America.
Support for the public option in the Congress has grown steadily as Members focused on the healthcare debate, and many single-payer liberals realized the public plan is the closest they can conceivably come in today’s Congress. But the latest surge of support has come from moderate Democrats and even Blue Dogs, who have come to the realization that if they are going to vote to force their constituents to purchase health insurance, they had better make sure they have a lot of choices – including an affordable public option. And they are realizing that if a public option can keep insurance premiums down, then the Federal government can afford to free up more subsidy funds to keep premiums reasonable for middle-class constituents, while keeping the overall cost of the health reform bill under a trillion dollars in the first 10 years.
As he overcame his conservative hesitations (and a lifetime of caution) and prepared to cast his vote for the historic 1964 Civil Rights Act, Republican Senator Everett McKinley Dirksen quoted Victor Hugo: “Nothing can stop an idea whose time has come.” And that helped get enough “moderate” votes to overcome a filibuster by Southern Democrats and conservative Republicans. Today Republicans are marching almost completely united in the opposite direction as historic reform. But, as the growing support for the public insurance option demonstrates, Democrats will find a way to unite in the Senate in support of the rule of democracy against the filibuster, and a strong and progressive health reform bill will pass the Senate with considerably more than a majority.
Once again, it is time to make history.