Hacker sees promise in Medicare buy-in

HACKER SEES PROMISE IN MEDICARE BUY-IN…. When the public option is described as a “new” idea, it’s a fair characterization. After all, as recently as 2004, the major Democratic presidential candidates — Kerry, Dean, and Edwards — all had fairly strong health care reform plans, but not one included a public option. It’s not that they opposed the idea; it’s that the idea hadn’t been crafted yet.

Credit largely goes to Yale political scientist Jacob Hacker, who crafted the idea for the public option, and which was quickly embraced by Obama, Clinton, and Edwards when they presented their reform plans in 2007.

Now that the Senate’s watered-down public option (with a state opt-out) may be scuttled, what does Hacker think of the state of the policy? He told PBS this week that the compromise framework is generally encouraging. (via Sargent and Stein)

“The way I would describe it is, in sort of Dickinson 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.”

Hacker’s praise was tempered by skepticism about the OPM plan — he doesn’t believe it will do enough “to provide the choice and competition” — but “enormous positive development” is nevertheless the kind of praise that should encourage lawmakers.

Hacker was especially pleased that progressive Senate Dems want the Medicare buy-in to be in place as early as 2011, which the political scientist said would give Americans “something that is concrete, that people will be able to see it changing lives very early in the reform process.”

Of course, the next question is whether the Medicare buy-in — described by Hacker as the “original idea … for the public option” — will survive. Before the compromise framework, reform had about 56 votes. After the compromise framework, it seems to have 58. As of late yesterday, Sens. Ben Nelson (D-Neb.), Joe Lieberman (I-Conn.), and Olympia Snowe (R-Maine) all sounded opposed to the deal, and without some combination of these three, 60 isn’t going to happen.

In a sane world, a bill with 58 supporters and 42 opponents would pass.