Wednesday, March 24, 2010

Public Option

As Ezra Klein notes, everyone now is speculating about how the newly reformed health care system will evolve (via Ezra, we have Cowen, Yglesias, and Douthat).  I wasn't going to post on this, because it seemed to focus on substantive policy issues, but after reading Klein's post, I realized that there's quite a lot of politics involved here that some of these pieces are overlooking.    What sparked it for me was this comment:

    I think there's virtually no chance that this system evolves toward single-payer.

Which then made me realize than none of these posts made any mention of a public option.  In fact, as I've argued, there's a very good chance that a future Congress will add a public option to health care reform as early as next year (if Democrats lose relatively few seats in the 2010 elections) or, perhaps more likely, 2013, should Obama be re-elected along with health Democratic majorities in both Houses of Congress.  This has little to do with how the current reforms are perceived, but everything to do with the politics of Democratic primaries, and the politics of passing legislation.  Basically, it's very likely that Democrats elected from 2010 on will be public option supporters, and once they're in Congress the public option is an attractive item to try to pass, because it scores well and can be done (almost certainly) through reconciliation.  Not only that, but because Democrats will be returning to the issue with more forceful and prominent positions on the issue, it's likely that the public option that will be adopted will be at least as "robust" as the most ambitious versions offered this time around. 

(I'll note that Chris Bowers argues that the big fight will be over expanding Medicare.  I'd be surprised if liberals move in that direction, rather than push for a public option.  If they do push candidates for, say, a Medicare buy-in at age 50 I suspect that they will be successful with candidates in very liberal districts, but much less successful in marginal districts -- and they'll face a lot more resistance to adopting it within Congress).

Now, beyond that, I have no predictions, but I will add that lots of people on both the left and right believed that once enacted, a public option was likely to expand over time, and that it was quite plausible that it would wind up expanding to become single payer.  Whether that is actually likely or not I'll leave to the economists and policy analysts, but I do think that if the Democrats retain their majorities we're very likely to get a public option as the final piece (for now!) of the Obama health care reform plan.

1 comment:

  1. Jonathan, perhaps you could define terms. Wouldn't early Medicare buy-in be one form the public option could take? It has the advantage that it has existing infrastructure, it is well understood, and it can be revenue neutral if the buy-in matches the true cost.

    Why would a Medicare buy-in public option be popular only in liberal districts? What other flavor would be more popular in marginal districts?


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