Jacob S. Hacker is the Stanley B. Resor Professor of Political Science at Yale University.
From the New Republic:”…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….So a bill must pass. Yet it must be a better bill that passes. And it must be understood by the President, the Congress and every American as only a step–an important but ultimately incomplete step–toward the vital goal that the campaign for the public option embodied: good affordable health care for every American.”