A Public Plan, Not Quite As Promised

On Saturday, Senator Joe Lieberman (ID-Ct.) told reporters

This is a kind of 11th hour addition to a debate that's gone on for decades. Nobody's ever talked about a public option before. Not even in the presidential campaign last year.

It would be doing deceit a disservice by suggesting that Senator Lieberman was merely stretching the truth or trying to deceive the media. The idea of the public option is nothing new.

On May 29, 2007, as The New York Times reported, Senator Obama gave in Iowa City, Iowa a speech in which explained that he

would create a public plan for individuals who cannot obtain group coverage through their employers or the existing government programs, like Medicaid or the State Children’s Health Insurance Program. Children would be required to have health insurance. Subsidies would be available for those who need help with the cost of coverage.

On February 24, 2008 The Washington Post reported

There is a growing political consensus among Democrats that universal health care can be achieved by subsidizing coverage for low-income people, establishing new purchasing pools to help others buy affordable insurance, and requiring most businesses to offer health plans to their workers or pay a fee. Both the Obama and Clinton proposals contain these elements, as well as the option to buy into a public plan. Their most striking difference is on whether to require everyone to get a policy.

The platform adopted by the Democratic Party (transcript, in PDF) at its 2008 national convention asserted

Families and individuals should have the option of keeping the coverage they have or choosing from a wide array of health insurance plans, including many private health insurance options and a public plan. Coverage should be made affordable for all Americans with subsidies provided through tax credits and other means.

Once Senators Obama and Biden were nominated, they proposed a health care plan (transcript in PDF) which would

create a National Health Insurance Exchange to help individuals purchase new affordable health care options if they are uninsured or want new health insurance. Through the Exchange, any American will have the opportunity to enroll in the new public plan or an approved private plan, and income-based sliding scale tax credits will be provided for people and families who need it.

For a candidate profile compiled by The Washington Post, Mr. Obama wrote

My plan builds on and improves our current insurance system, which most Americans continue to rely upon, and creates a new public health plan for those currently without coverage.

Both Congress and the President, whether considering an opt-out, a trigger, a triggered opt-out, have come a long way since the Obama-Biden plan promised "through the Exchange, any American will have the opportunity to enroll in the new public plan...." It's not as if we weren't warned: in President Obama's health care speech to the joint session of Congress, he assured Americans

Let me be clear. It would only be an option for those who don't have insurance. No one would be forced to choose it, and it would not impact those of you who already have insurance. In fact, based on Congressional Budget Office estimates, we believe that less than 5 percent of Americans would sign up.

"Any" American being eligible for a public plan had become "less than 5 percent of Americans" signing on to the public option.

An exasperated Senator Sherrod Brown (D.-Ohio) explained the process to a New York Times reporter:

A large number of people in this country including many, many doctors wanted Medicare for all. That didn’t happen. Then we wanted a strong public option tied to Medicare rates. Then we wanted a public option building the Medicare network. That didn’t happen. Now we are saying public option coming out of the HELP Committee. And now we’re saying public option with the state opt-out. Where was the compromise coming from their side?

One would think, then, that Lieberman andd conservative Democratic senators would be satisfied that a bold candidate, promising a government option to all Americans, and overwhelming Democratic majorities in both houses of the legislature are now reduced to pleading that a vote be held on a health care bill far weaker than they had envisioned. Yet, as Brown understands, with every concession the goal posts keep getting moved, with liberal/moderate Democrats reduced to working to pass legislation they can only hope will improve the nation's health care system merelu at the margin.