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Examining the Public Option in Health Care Reform

In the latest in a series of conversations with key players in the health care debate, Jeffrey Brown speaks with Jacob Hacker of Yale University, one of the key proponents of a public insurance option.

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  • JIM LEHRER:

    Finally tonight, Jeffrey Brown has the latest of our conversations about health care reform.

  • JEFFREY BROWN:

    In our previous conversations, we have sought the views of a leading hospital CEO, the head of a major health insurer, a former-executive-turned-critic of the insurance industry, and a writer who studied the health systems of other countries.

  • Tonight:

    one of the earliest and leading proponents of the so-called public plan, which has become such a focal point in the contentious debate over health care reform.

    Jacob Hacker is a professor of political science at Yale University and a fellow at the New America Foundation.

    Let me ask you first to define the term. That — that will help us get started. What exactly do you mean by a public plan?

  • JACOB HACKER:

    A public plan is pretty simple to understand.

    It's a — a plan that would be modeled after the Medicare program that Americans are familiar with and like. It would be available to those Americans who didn't have good coverage from their employer. It would also be available to workers who worked in the smallest firms. And it would be made available through some kind of new insurance-purchasing exchange, through which people could get access to both private health insurance plans and this new public plan.

  • JEFFREY BROWN:

    And why is it necessary? What — what — how does — how does it do something that you see lacking in the system that we have now?

  • JACOB HACKER:

    I like to talk about the three B's of — of the public plan, that it will be a backup for people who don't have secure coverage today and who want to have a broad choice of doctor, because a Medicare-like plan can provide a very broad choice of doctors and hospitals.

    Second, it's going to be a benchmark for private insurance plans. You know, the private insurance market has gotten increasingly consolidated over the last two decades. And, in many parts of the country, 94 percent of local markets, according to the AMA, there really isn't effective competition for private insurers.

    And, finally, it's going to be a cost-controlled backstop. That means that it's going to be able to be one of the levers for bringing down costs over time, both by creating a check on private insurers and by innovating in the delivery of and — and payment for care.