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Health Care Reform 2009, Part 1: Jacob Hacker

This is the first part of a five-part primer on the basics of this summer’s health care reform debate.  Whether you’re totally new to the discussion or just need help clarifying some things (like, “What does “OMB complains about CBO scoring of Medicare Advisory Council” actually mean, anyways?), this primer should bring you up to speed. Here’s how we’ll break it down:

  • Part 2: The White House- the Obama health care reform team
  • Part 3: Congress- who’s working on what
  • Part 4: The Bills- what’s in ’em and where they stand
  • Part 5: Lobbyists- who’s working for and against health care reform

But first, let’s start at the beginning…


photo of Jacob Hacker

Jacob Hacker: Godfather of the Public Option

Who?  Probably one of the most important figures in shaping the current health care reform debate, yet it seems like outside of wonky policy experts, nobody has heard of him.  While Hacker was a PhD student at Yale, he wrote a book about the failure of Bill Clinton’s health care plan called The Road to Nowhere.  In it he concludes that Clinton’s plan failed because it was basically too complex and scared people with unfamiliar, untested concepts like “global budgets” and “managed competition.”

Following that book, Hacker designed his own plan, Health Care for America (HCA), meant to avoid some of the pitfalls of the Clinton proposal.  Ezra Klein explains:

“Hacker’s plan works on a few basic principles.

  • First, no one loses what they already have. You like your current insurance? Keep it, unless your employer kicks you off.
  • Second, a new group market is created (the Health Care for America market), where insurers can compete for the business of individuals and employers (who can buy their employees in for 6 percent of payroll).
  • Third, the group market contains a strong public insurer modeled on Medicare, creating competition between private insurance companies and the public offering. The hope is that the public insurer, which will not need to turn a profit and will be free of some of the perversities of private insurance, will prove the most cost-effective and attractive option, leading individuals and businesses alike to gravitate toward it. Over time, it would evolve into something approaching a single-payer system.”

Sound familiar?

Last year, Campaign for America’s Future, an influential progressive political organization, worked hard to push Hacker’s Health Care for America to all the major democratic presidential candidates.  Which is why the Clinton, Obama, and Edwards health reform plans were so similar during last year’s primary– all of them were based on Hacker’s proposal.  And with Obama in office, it’s no surprise then that the health care reform bill that Congress is discussing looks a lot like Health Care for America.

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