For two decades, Yale Professor Jacob Hacker has been almost singularly known for an idea he conceived of while still a graduate student. So the question seemed obvious: Was he sick of being “the public option guy?”
“To be honest, I think if you can be associated with one good policy idea in your life,” Hacker told Blue Tent in a recent phone interview, “I think that’s a pretty good record for an engaged academic.”
The one policy idea Hacker’s known for may soon be at the very center of debates on Capitol Hill, in the Biden administration, on cable news and across social media. After a Democratic primary dominated by discussions of Medicare for All, which overlapped with an ongoing public health crisis, healthcare reform is poised to be one of the Democrats’ top priorities in 2021. Lawmakers across the ideological spectrum are pushing plans that would give people the choice to get their insurance from the government, similar to Medicare. In policy circles, Hacker is widely known as “the father” of the idea for a public option.
“I’ve been in this expectant father role for a long time,” Hacker said, laughing. “Yet the public option has not emerged from the womb of Washington. There’s been a very, very long gestation period, and I’m really hopeful that we’ll see the actual birth of the public option in the near future.”
With the pieces in place, it seems like the public option is having a moment—but Hacker and his brainchild have been here before.
A missed opportunity in 2010
A decade ago, when the Obama administration and Congress were hammering out what would eventually become the Affordable Care Act, a public option was the most ambitious and expansive idea being taken seriously by leading Democrats. Hacker published reports, testified in front of Congress and advocated in the media for his plan, but it wouldn’t come to pass.
“The darkest day for me was when the New York Times ran a story in which [then independent Senator] Joe Lieberman said that he was against a compromise idea that Senator Sherrod Brown supported, a Medicare buy-in, because I was for it,” Hacker said. “He’s like ‘Jacob Hacker, who’s the father of the public option, said this is great, this is better than the public option.’ And of course, I never said that, I didn’t believe it, but I was open to compromise.”
Whether or not Lieberman was making his choices based on “some obscure academic,” as Hacker described himself, without the Connecticut senator’s support, anything even resembling the public option was dead. Little did anyone expect that 10 years later, Hacker’s signature idea would be resurrected by the likes of Joe Biden. For Hacker, Biden’s minimal commitments to specific policies, paired with his focus on “process and people,” may suit him well to be pushed into bold action.
“In general, Biden does not seem particularly ideological,” Hacker wrote last May in The American Prospect, “comfortably placing himself near the center of his party wherever it happens to be at the moment.”
At this moment—thanks in part to Medicare for All advocates like Sen. Bernie Sanders and Rep. Alexandria Ocasio-Cortez—the party’s center has widely come around to accepting a public option, which was featured in nearly every Democratic presidential candidate’s platform. The healthcare lobby has taken notice. After Sanders bowed out of the Democratic primary, the Partnership for America’s Healthcare Future, an insurance and health industry association, switched from running ads and talking points against Medicare for All to a full-throated attack on the public option.
An en vogue policy in need of a grassroots push
From K Street to the halls of Congress, Washington is gearing up for another massive health reform battle. Hacker hopes to be “at the center” of those fights. While he demurred when asked to name key scholars and policy experts who will play a decisive role in public option debates, he noted a few “unheralded” members of Congress leading the way on healthcare. In 2019, Hacker helped Reps. Rosa DeLauro and Jan Schakowsky in crafting their Medicare for America Act; he also met last year with Senators Jeff Merkley and Chris Murphy, discussing health policy over Oregon microbrews in Merkeley’s senate hideaway.
“Public option plans now are proliferating like rabbits, and so there’s a lot of them jumping around on Capitol Hill,” Hacker said, “And that’s a big change and an important and positive change.”
Another big difference, Hacker notes, and one that could be decisive for serious action in 2021 and beyond, is the continued presence of grassroots pressure.
“To me, the missing element in the debate for a long time has been a kind of broad-based push from those who are concerned about the way in which the system is falling short, [a push] that is substantial enough to overcome the huge number of vested interests in that system,” Hacker said.
Hacker likes to cite an anecdote about President Franklin Roosevelt’s meeting with activists urging him to support legislation. After they made their case, the story goes, Roosevelt told them, “You’ve convinced me. Now go out and make me do it.”
Biden has promised major action on healthcare, but Hacker isn't getting his hopes up. Reached for a follow-up after Democrats secured a slim Senate majority earlier this month, Hacker told Blue Tent that he still considers the public option "a very hard lift" for Democrats. Hacker believes that if a public option remains infeasible in the short term, Democrats in Congress must continue to build on the ACA, encourage states to experiment with public plans, and feed the grassroots movements pushing for structural healthcare reform.
“We’re in a movement moment, if you will, with a series of grassroots initiatives around issues of racial justice and healthcare and political reform,” Hacker said. “And I think that movement energy needs to be harnessed for reform. I know a lot of the people in those movements believe that we could move to Medicare for All overnight. I’m more skeptical, but I think that pressure is really important.”
Update: This story has been updated to include Hacker's comments after the January 5th Georgia run-off elections.
