Health Policy Scholar Who Said the Public Option Would Lead to Single Payer Now Says You Shouldn't Worry that the Public Option Will Lead to Single Payer

In 2008, Jacob Hacker called the public option a slow path to a government-run health insurance system.


In an op-ed for The New York Times, Yale political science professor Jacob Hacker argues that Obamacare's problems can be fixed by the addition of a "public option"—a government-run health insurance plan that would be available in the exchanges alongside private options.

Near the beginning of the piece, Hacker, who has been touting the public option since before Obamacare was signed into law, dismisses one of the major lines of criticism about the creation of a new, government-run health insurance plan, which is that it would lead to fully government-run health insurance system.

"Critics of the public option are convinced it's a one-way ticket to single payer (the government alone provides coverage)," Hacker writes. "History suggests the opposite: The public option isn't a threat to a system of broad coverage through competing private plans. Instead, it's absolutely critical to making such a system work."

Now, I have argued in the past that Obamacare is unlikely to lead to single payer in the long run, and I still believe that a fully government run system is an unlikely outcome, at least in the forseeable future.

But one could be forgiven for thinking that the inclusion of a public option would eventually lead to a single-payer system, because that is exactly what Jacob Hacker said would happen when he pitched the public option in 2008.

In a 2008 speech to the Tides Foundation, a liberal policy organization, Hacker touted his then relatively new idea for creating a new government-run health care plan available to all Americans. In his remarks, he explicitly addressed the possibility that it might eventually lead to a government takeover. Here's what he said:

Someone once said to me, 'Well, this is a Trojan horse for single payer.' Well, it's not a Trojan horse, right? It's just right there!

I'm telling you, we're going to get there over time, slowly, but we'll move away from reliance on employment based health insurance as we should. But we're going to do it in a way that we're not going to frighten people into thinking that they're going to lose their private insurance.

These remarks were captured on video. Watch below:

In 2009, after the video aired on Fox News, Hacker backtracked, saying that he did not see his plan as a route to single payer. That appears to be his position still.

But it wasn't at first, when he was speaking to a liberal audience. And the dynamics he explained in 2008 certainly provide a plausible enough foundation for the idea that a public option would lay the groundwork for more government intervention.

So it is hard to fully trust Hacker's current assurances that a public option would not eventually lead to single payer given his previous explanation that it would.

Update: Hacker writes in to disagree.

"If you listen to the speech or look at the figure I displayed, it is clear that I'm talking about the gradual replacement of private employment-based insurance with a public insurance pool that gives participants a choice between public and private plans, just as the Medicare program does. My writing and speaking on this have remained totally consistent. Clearly the "Trojan Horse" joke was too clever by half…but again, it's clear from the chart I'm pointing to and my subsequent discussion during that speech that I'm talking about the move away from employment-based coverage toward a publicly overseen system of competition in which a public plan is offered."

It's not the same public option that we're now talking about with Obamacare, but a public plan is part of the mix, and Hacker's work on a Medicare-style public option replacement is part of the public option timeline.