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.

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  1. It’s called the Gruber effect: proggies can do this all day, and they don’t care.

  2. 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.

    Wouldn’t want to spook the cattle on their way to the slaughterhouse.

    1. We’re all for democracy, but not too much democracy.

      Sometimes, what the voters don’t know won’t hurt them.

      Have we told you of our vague support of the 2nd Amendment, without really describing what that means?

    2. A couple days ago one of the architects of Obamacare was interviewed on TV about the skyrocketing costs. I kid you not — his solution was more and better advertising to get young healthy people to join the exchanges. He apologized for nothing.

      1. The Great Orator in Chief has been out there shilling for Obamacare like a late night infomerciall for years. How much more advertising can you get.

      2. So, like, more dudes doing kegstands touting “brosurance”?


        I can’t believe that didn’t work the first time around.

        1. Skyrocketing premiums, astronomical deductibles, limited networks, a good chance of seeing one’s plan dropped next year? Why aren’t plans flying off the shelf?

  3. War is Peace. Freedom is Slavery. And, as we see here, Ignorance is Strength.

    1. I keep believing I will wake up and it will all be a bad dream…

      1. Don’t eat the blue pill!!!!!!111!!

  4. Oh, maybe he’s telling the truth this time!

  5. “single payer (the government alone provides coverage)”
    Let’s just have the government pay for everything. Not just health insurance, college, child care … everything
    Then have the Fed buy all the Treasuries to pay for it. No more taxes. No more expenses.
    No need to need to raise the minimum wage because everything will already be free.

    1. Be careful what ideas you give these unrealistic progressive nutjobs.

      1. I’m trying to adapt my thinking to the new world order.
        Upon further reflection, the minimum wage should be raised too, and not just to a living wage.
        Everyone should live in the lap of luxury. For fairness. For the children.

  6. So den I sez to th’guy, “hey, youse like yer liddle store you can keep it, long as deez neighborhood guys don’t wreck it or nuthin. I don’t know why’d dey do sometin like that but, hey, ya never no.

  7. Immediately repeal ObamaCare after Trump is President!

  8. “. . . but we’ll move away from reliance on employment based health insurance as we should.”

    Jesus, this is rich. Government tied health insurance to employment.

    1. Progs don’t do irony

    2. They took an inadvertent and relatively undesirable outcome of tax policy and made it mandatory. Great job guys.

      1. I really meant wage control policy.

    3. Tying it to employment allowed people to buy in groups and combine their risk. Have everyone buy it individually, then health insurance is affordable just so long as you are a low risk and don’t need it.

      Progs don’t hate employee provided health insurance because it messes with the market. They hate it because it largely worked and has caused people to like their health insurance and not support single payer. They want to get rid of it because they know doing so will leave people who are bad risks with no way to afford health insurance and thus cause people to turn to single payer. And Libertarians seem to want to help them do that

      1. The one thing I don’t understand, well one of many actually, is this:
        Why does insurance company X have separate pools of customers within the same state?
        As I understand it, insurance company X has a separate pool for individual customers than it does for small business customers than it does for large company customers (and maybe there are even more pools than those).
        I know that laws/regs prevent insurance companies from selling across state lines, but is it the govt or the insurance company that is preventing all of the customers within the same state for that insurance company to be in the same risk pool of that company?

        1. The pool thing is some kind of bullshit they use for rates, probably due to government intervention.

          There is always exactly one pool.

        2. Regulations define the pool…

      2. Ultimately it comes down to the idea of health care being a “right”. They consider it unacceptably immoral that the guy with gonaherpasyphilAIDS and cancer of the face might not be able to get every treatment he needs due to finances. As long as that belief persists, everything else is just background noise.

        1. Especially if that person votes instead of works for a living..

      3. The problem is people change jobs and can’t stay in the group.

        Anyway a person who is a “bad risk” does not need insurance anymore, it’s too late for that if they didn’t have it already. They need charity.

      4. Everyone buying individually allows MORE risk sharing, not less.

        Realistically, it makes no difference, the pool is the same size either way. The only advantage to the employer is that the it is probably a bit of savings on paperwork processing thru one source than individual sources.

        But it works out just fine for all other forms of insurance. I dont need to buy my home insurance thru the HOA.

        1. Exactly. John should know that libertarians are generally ok with people buying shit however works best for them, and are confident enough in our ability to meet demand in a free market to not continue using government force to maintain an arbitrary status quo.

  9. I think that Yale should give everyone free health care

    I don’t know how they will do it but they are so smart they will figure it out.

  10. But Sudernman’s dingbat wife claims Gruber is a good guy who means well. The revealing video of Gruber is not the one where he talks about lying to pass Obamacare. It is the one where the people in New Hampshire have a list of questions about their health insurance that Gruber plans to fuck up and he says “what were theese questions written by 8th graders?” Watch that video and try not to feel the desire to beat the little bastard within an inch of his life. You won’t succeed. Bribed is one of the most immoral, worthless creatures ever to inhabit public life. But he will always have McArdle to tell us how he means well.

    Meanwhile, e’tu AI? I wonder if Bailey, who believe anything as long as it is technology has seen this.


    1. I can’t find any real details on the algorithm, but apparently it primarily gauges public engagement from social media, etc. The question of polling vs. engagement has been an interesting one this cycle. Trump lags in polls but routinely packs 20k into arenas for his events. Shy Trump supporters? Inadequate sampling/poor definition of “likely voter”? Just a very hardcore, but relatively small group of supporters for Trump? After the actual election, all of this will be interesting to dig through.

      1. It has nailed the last three elections. Maybe it is lucky. Who knows. I just think it is funny to contemplate Bailey, a guy who will believe anything technology tells him but is also a true believer in whatever Washington conventional wisdom tells him, being confronted with this.

  11. “Health Policy Scholar” isn’t a thing. If it was, I’d expect someone with an MD and/or MPH and at least a bachelor’s in economics.

    This dude is a political science prof. He has a BA in Social Studies and a PhD in political science.

    Who could’ve expected the author of American Amnesia: How the War on Government Led Us to Forget What Made America Prosper to be even-handed in his approach to government intervention?

    1. None of these wanna be top men are ever qualified to have an entry level job in the fields they claim to be able to manage.

      1. But they know what right thinking people should think and believe! How couldn’t that make them better than the rubes?

  12. Oft times, on different commentary sections, I see comments that ask can’t we have political discussions without the need to insult the intelligence of someone who disagrees with you. But I contend that anyone who believes this kind of bullshit seriously needs their intelligence questioned. There is ABSOLUTELY no way to introduce a “public option” that does not lead to single payer. Even Krugman’s fucked up economic philosophy couldn’t explain otherwise. Insurance companies are bailing on the exchanges because they are losing money hand-over-fist, so let us add a competitor to the exchanges that dramatically undercuts the price insurance companies are charging. That will absolutely help them make money and stay in the exchanges. There is no word in the American lexicon to describe this level of stupidity.

    1. Yes Bill. These people are stupid and should be called such.

      1. Oh, I doubt these people are stupid. In fact, I am starting to believe they know exactly what they are doing. In the end these top men have an agenda, and that is control and power, and then, at any and all costs. That they have to destroy healthcare as we know it doesn’t faze them, because as part of the intelligentsia, they believe they will always have access to something other than whatever abomination they foist on the plebs.

    2. “can’t we have political discussions without the need to insult the intelligence of someone who disagrees with you.”

      That sounds like a really good idea. They could start by admitting O-care is a complete fuck up and needs repeal or they can insult MY intelligence and expect to get it back.

      1. What Sevo said.

  13. We had a new lefty troll last night claiming we’re saving money, since Brookings Institute said the rates might be even higher than they are if we didn’t have O-care. And Brookings’ guess is better than any data.
    BTW, you notice the lefties and their rags are no longer calling it “O-care”. Nope, not since it’s obvious it’s tanking.

    1. It always comes back to “but it would have been worse” with these assholes. It is a cult. They never learn.

      1. “rates might be even higher”
        I’ve been buying insurance in the individual market for oodles of years. Premiums went up every year by a fairly consistent and manageable rate, then they went crazy. In 2013 I paid $1800/yr in premium. I’ve raised my deductible since then to try to lower the premium, yet my premiums next year will be $5400. That’s a 3x jump in 4 years. I call bullshit that anything other than Obamacare created this insurance premium hyperinflation.

        1. Making everyone buy coverages they did not want or need and effectively buy insurance for every possible contingency raised rates? Who could have seen that coming? Just bad luck I guess.

          1. It is poetic justice that you can get a colonoscopy for no additional cost.

            1. No you can’t. You still have to pay the anesthesiologist full rate or take it while conscious…

              1. The hurt feels so good!

  14. I’d have to forget everything I know about economics to think that a government subsidized program without any fear for profitability or its financiers (taxpayers) voluntarily pulling the plug wouldn’t crush the competition.

    Let’s also not forget that the public option we’re talking about would almost certainly look like Medicaid.

    For the millionth time, the reason Medicaid costs taxpayers so little is because providers gouge private pay patients for the money they lose providing care for Medicaid patients. Medicaid pays, on average, about 12.5 cents for every dollar billed. To get a sense of what that means in terms of profitability, Medicare pays, on average, about 25 cents on every dollar billed–and providers still, on average, lose money on every Medicare patient.

    What I hope people understand is that if the government puts forth a public option, the public option will not be more expensive for the taxpayers than Medicaid–if it were, they would just put more people on Medicaid. And the whole point is that effectively expanding Medicaid is a double-edged sword. Not only does it provide more low cost competition for private insurers on the exchanges–it also means that providers will be suffering even more losses because of the Medicaid expansion.

    1. As I recall, it’s a non-trivial task to find doctors who will accept new Medicaid (or maybe it’s Medicare) patients.
      For reasons outlined above.

      1. Oh, the public option and the collapse of private insurance would take care of that.

  15. A public option, therefore, would definitely crush private competition eventually. The only question is whether it would do so in four years, 12 years, or 25 years. Maybe crushing the private insurers took long enough, we might have a libertarian in office who would replace the public option with private competition rather than single payer. It would take a committed libertarian to make that happen and leave millions of people without coverage however.

    Regardless, that is how and why the public option will lead us to single payer. It’s important for people to understand that, and it’s important for them to understand that it’s an excellent reason to vote for a libertarian to vote for Trump. If Hillary is in office when ObamaCare collapses, she will refuse to sign any reform that doesn’t include a public option. Putting Hillary in office almost assures us that we will have single payer in this country. If Trump is in office when ObamaCare collapses, he will not veto any legislation that reforms ObamaCare because it doesn’t include a public option.

    1. Re: Ken Shultz,

      It’s important for people to understand that, and it’s important for them to understand that it’s an excellent reason to vote for a libertarian to vote for Trump.

      As long as one does not mind the mercantilism and the economic autarky that he’s proposing as a “solution” to the woes of the Buggy Whip industry. The important thing is to beat HillRod!

      1. No, I didn’t say that.

        I just said that it was a distinction between Hillary and Trump that makes a difference.

        Because neither Hillary nor Trump are excellent choices does not mean that one of them isn’t better than the other.

        The facts are:

        1) The ObamaCare exchanges will probably collapse under the next President.

        2) Hillary Clinton will veto any reform of ObamaCare that doesn’t include a public option

        3) The Republicans will not have the votes to override her veto.

        4) The public option leads to single payer and the end of private insurance.

        5) Donald Trump will not veto a reform of ObamaCare because it doesn’t include a public option.

  16. “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.”

    Being a political science professor doesn’t mean you have a good grasp of logic or at least in the case of Hacker, that is the case.

    Hacker establishes the argument he pretends to answer and then comes back with something that is completely irrelevant:

    1) Critics say the public option is a one-way ticket to single payer
    2) History shows that the public option is essential to make the marketplace work [an unsubstantiated assertion, by the way]
    Ergo: The critics are… wrong?

    The answer does not provide a direct rebuttal of what the critics say, except a reassurance that the public option is needed and, so, there! In argumentation, Hacker’s answer is known as a Non Sequitur.

  17. My main think is if that plans can benefits for many people why not! 🙂

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