A public option is a new idea

A PUBLIC OPTION IS A NEW IDEA…. Reform advocates want a public option. Reform advocates should want a public option, because it’s a good idea. But it’s interesting to note that just how new an idea it is.

Ezra Klein noted a couple of weeks ago that major health care reform initiatives — Bill Clinton’s plan, Howard Dean’s plan, John Kerry’s plan — were all considered worthwhile proposals by reform advocates. Indeed, in each instance, supporters of health care reform endorsed these plans with some enthusiasm. But not one of them included a public option as part of the policy. “It is a recent addition to the debate, and a good one,” Ezra noted. “But it is not the reason we are having this debate. Rather, what has kept health-care reform at the forefront of liberal politics for decades is moral outrage that 47 million of our friends and neighbors are uninsured.”

Dean is now arguing a public option is integral to reform, and that Democrats who fail to support a public option will likely face primaries. It’s a bold position from a party leader and former physician whose signature issue has always been health care — and I’m glad to see Dean take it. That said, Ezra took another look at Dean’s plan from 2004.

The Vermonter was, of course, one of the more liberal candidates in the race, and the most oriented toward health care. But there was no public plan in his proposal. There wasn’t even a co-op. Dean’s plan would have insured millions fewer people than the bills being considered in the House or the bill that we think we’ll see out of the Senate. As I read the policy — and it’s possible there’s a more detailed summary than the one I’ve dug up — it didn’t even include insurance market reforms like banning discrimination based on preexisting conditions or outlawing rescission.

For all that, it was a good and well-meaning plan. But it was a lot worse than what we’re considering now. It was a lot worse even than the compromises we’re considering now…. But it was considered, at the time, a good plan, and it was.

Now, the point here isn’t to criticize Dean. On the contrary, I think Dean’s right and I applaud his ongoing efforts. Our political system needs more Howard Deans. He sees a rare opportunity to bring significant changes to a system that needs them, so he’s fighting against compromises and watered-down half-measures that would weaken the Democratic vision. If Dean’s approach wins, Americans will benefit.

What’s more, the Democratic majority can achieve these goals, if they’re willing to fight for them. I sincerely hope they do.

That said, after reading Ezra’s item, I had a thought experiment. If someone told had told me, the day after George W. Bush won a second term in November 2004, “Don’t worry, in just five years, we’ll see a Democratic president pass a health care reform bill that’s even more progressive that Howard Dean’s plan,” I would have been more than a little thrilled.

It wouldn’t have occurred to me to ask, “But will it have a public option?”