No policy proposal has had a wilder roller-coaster ride in the Obama administration than the public option. It emerged as a central tenet of the comprehensive health care reform plan early on; Republicans then attacked it as a slippery first step to a single-payer nationalized health care system, even as liberals, railing against too many compromises, embraced it as a litmus test for "real" reform. By the time the election of Sen. Scott Brown in Massachusetts, it was long assumed to be dead and buried. But not quite: Eighteen Democratic senators have now joined a petition to bring it back.
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Opinions vary as to whether the public option has a pulse again. Here, activists participate in a candlelight vigil for health care reform near Capitol Hill in December.
How will this latest push end? The smart bet remains against passage -- but as the following timeline shows, the history of the public option has had plenty of sudden plot twists.
2001 -- The Public Option Is Born
Yale professor Jacob Hacker is credited as the inventor of what is now known as the public option. In a 2001 paper written while he was still a graduate student, Hacker envisioned an insurance option, which he dubbed "Medicare Plus," for people who did not have employer coverage or Medicare. But with Democrats out of power for the next eight years, Hacker's plan received little attention beyond the academic policy community.
2004 -- Democratic Promises, Sans Public Option
The words "public option" did not appear in the 2004 campaign health care plans of either John Kerry, the eventual Democratic nominee, or Howard Dean, both of whom are now pushing strongly for the public option. Instead, Kerry proposed allowing Americans to buy into the health care plan offered to members of Congress, while Dean wanted to offer the federal employee plan more broadly.
2007 -- Hacker's Plan Resurfaces
With a slew of Democratic candidates gearing up for a 2008 White House run, Hacker returned with another paper outlining his public option plan, which he titled simply: Health Care for America. "Every legal resident of the United States who lacks access to Medicare or good workplace coverage would be able to buy into the 'Health Care for America Plan,' a new public insurance pool modeled after Medicare," he wrote. With help from another key Democratic policy player, Roger Hickey, the public option became integrated into the health care plans offered by presidential front-runners Barack Obama, Hillary Clinton and John Edwards. Yet as Obama himself later noted, the public option was never a central element of his health care platform, at least as he emphasized it in public remarks. It was also relegated to a passing mention in his official campaign proposal.
Early 2009 -- The Public Option Gets Its Day in Congress
Of the five congressional committees that worked on health care throughout spring and summer of 2009, four panels included a public option in the legislation they approved. They included the Senate health committee, which Sen. Ted Kennedy chaired before his death in August. But the committee that spent the most time and drew the most attention, the Senate Finance Committee, did not include the public plan, as chairman Max Baucus, D-Mont., scrapped it in an attempt to win bipartisan support.
July 2009 -- The White House Blinks
In an interview with The Wall Street Journal, Chief of Staff Rahm Emanuel signaled that the White House would accept a health care bill without a public option, despite the president's repeated statements of support for the proposal. This acknowledgment, which drew fire from the left, may have been the beginning of the end for the public option; it crystallized the notion that the president wanted the measure but would not fight hard to keep it.
August 2009 -- Liberals Make Themselves Heard
With criticism reaching a fever pitch at town hall meetings across the country, and the White House sending signals that it was not a crucial policy element, 60 House liberals sent a letter to the administration demanding that the public option be included in a final bill. Days later, House Speaker Nancy Pelosi said the message was received. "There's no way I can pass a bill in the House of Representatives without a public option," she told reporters.
September 2009 -- Obama Makes the Case. More or Less.
By the end of the summer, Democrats were on the ropes, struggling to defend a plan that had taken a beating in August. Answering demands that he weigh in with specifics, President Obama went before Congress and the nation in September. He included a lengthy argument in favor of the public option, but critically stopped short of insisting that it be included in the final package. "Its impact shouldn't be exaggerated -- by the left or the right or the media," the president said. "It is only one part of my plan, and shouldn't be used as a handy excuse for the usual Washington ideological battles."
November 2009 -- The House Passes Its Version
Pelosi is proved right in her earlier prediction as the House narrowly passes a health care overhaul that includes the public option, although it was a version weaker than some progressives had pressed for.
November 2009 -- The Senate Looks Like It Might Follow Suit ...
The public option reaches perhaps its high-water mark on Nov. 18 when, despite expectations to the contrary, Senate Majority Leader Harry Reid included it in the long-awaited official Senate version of the bill.
December 2009 -- ... Until It Doesn't
After months of back and forth, the public option lasted all of three weeks in the upper chamber. Reid dropped the proposal after centrists like Sens. Joe Lieberman, I-Conn., and Ben Nelson, D-Neb., said they would not vote for a bill that included it, meaning the Democrats would not have the 60 votes needed for passage. Reid initially replaced the public option with an optional expansion of Medicare, but that also fell by the wayside once Lieberman voiced his opposition.
December 2009 -- Senate Passes Its Public Option-less Bill
As expected, the Senate bill that passed narrowly on Christmas Eve contained no public option. With Lieberman and Nelson warning against major changes when the House and Senate merged their bills, little hope remained for its revival.
January 2010 -- Health Care Stalled, Public Option Buried
Thrown into disarray by Brown's stunning election in Massachusetts, health care itself was an afterthought when Obama addressed the nation in his State of the Union speech. The public option, now presumed a relic of a debate that had long since shifted, didn't come up.
February 2010 -- The Public Option's Lazarus Moment?
The administration proceeded on two tracks in February: renewing outreach to Republicans with a bipartisan health care summit while simultaneously working behind the scenes in Congress to forge an agreement with House and Senate leaders on a Democrats-only bill that could pass the Senate through the so-called budget reconciliation process, which requires a simple majority of 51 votes. As the health care summit approaches, Senate liberals are making one last push. Eighteen of them have now signed onto a letter asking for a reconciliation vote on the public option. That is well short of the 51 needed to pass, but the movement got a key boost from Sebelius, who told MSNBC's Rachel Maddow that the White House would "absolutely" support the public option "if it's part of the decision of the Senate leadership to move forward."
So: Does the public option really have a pulse again? Opinions vary. One argument goes that if the Democrats are going to pass a bill through the reconciliation process, they might as well go for as much as they can, and many in their caucus believe the public option is simply the best policy choice available. Another is that it's all just an effort by a bloc of Democrats to ingratiate themselves with a party's base already steaming over an agenda gone awry. Even some supporters of the public option, notably The Washington Post's Ezra Klein, suggest that the latest campaign is a fool's errand, jeopardizing remaining chances for any health care bill by reopening an explosive debate that has already been lost. "A zombie public option debate could well drag health care reform into the grave as well," Klein argues. What it would certainly do is add one more twist to a ride that never seems to end.
