Is the Public "Option" a Trojan Horse for a Single-Payer Plan?

“Someone once said to me, ‘This is a Trojan Horse for single-payer,’ and I said, ‘Well, it’s not a Trojan Horse – it’s right there! I’m telling you: we’re going to get there, over time, slowly.’” Jacob Hacker, professor of political science at Yale, and author of the basis of the healthcare "re-form" plan that Obama and Ds are selling. (Youtube video July 2008) [1]

The Trojan Horse story teaches us to beware of foes bearing gifts. Healthcare "re-formers" bring gifts to the people with today's healthcare "re-form" legislation. Professor Jacob Hacker denies any stealth in the gift of the public "option," since it's obvious to him that the public "option" will lead to socialized healthcare in the US. While acknowledging the inevitability of single-payer, Hacker is still careful with his terminology, using "single-payer" instead of "socialism". President Obama (D), politically constrained as Anita Dunn pointed out, can no longer even proclaim his professed goal of a universal single-payer plan.

So the President denies that the public "option" will lead to socialized healthcare. In a speech on June 11, 2009 at a town hall rally for healthcare "re-form" in Green Bay, WI, Obama disingenuously described R opposition to a public health insurance option in the healthcare re-form bill (video):

"It's not clear that it's based on any evidence, as much as it is their thinking, their fear that somehow once you have a public plan, that government will take over the entire healthcare system."

But it's not only Rs who see it as a step to socialized healthcare, "progressive" Paul Waldman, an advocate for socialized healthcare, explains in a December 23, 2008 American Prospect article:

"That isn't to say a public option is just a modified single-payer system. It would be one option among many for individuals and businesses, and would leave the private insurance system in place (you can read more on the benefits of the public option here). But it does crack the door open for expanding the number of Americans who get their health insurance through the government."

The Trojan Horse Strategy

While the President denies that the public "option" is a Trojan Horse for a single-payer healthcare system, what do other healthcare "re-formers" say?

Rahm Emanuel (D), the President’s chief of staff, "Mr. Don't-Let-a-Crisis-Go-to-Waste," clearly states how you are being lied to by the President in this video from June 17, 2009:

Socialized Healthcare Supporter: "Hey Rahm, why'd the President take single payer off the table? In 2003 he said he was for single-payer, now he's against it, why did he flip-flop?"

Emanuel: "Because it's just what I said in there. The objective is important, it's not the means."

Healthcare for America Now (HCAN) spokesman John Gaudette, speaking at a monthly meeting of the Progressive Democrats of America in May 11, 2009 outlines the strategy (at 3:00 in this video):

"...the public health insurance option is the thing to do because that's what's winnable. And you can make that strong enough and leave it to the American people to determine where this thing goes, its much easier to fix legislation when its created than to create something new, and that's something important to remember. This tension, this idea that we can hold out for something that's as grand and hopeful as we want tends to run counter to what's going on in DC."

In this one minute video, Gaudette, like Hacker and Emanuel, advises single-payer supporters to be patient, the public "option" will become single-payer. Gaudette credits congresswoman Jan Schakowsky (D) from the Illinois 9th district, part of the House D leadership, for pushing the public "option." Watch this video of Schakowsky speaking to advocates of single-payer healthcare on April 18, 2009, as she vehemently affirms the strategy:

"And next to me was a guy from the insurance company, who then argued against the public health insurance option, saying 'it wouldn't let private insurance compete, that a public option will put the private insurance industry out of business and lead to single-payer.' (audience cheers)

“My single-payer friends, he was right. The man was right... I know that many of you here today are single-payer advocates and so am I... Those of us who are pushing for a public healthcare option don't disagree with the goal. This is not a principled fight. This is a fight about strategy for getting there, and I believe we will.”

Wisconsin senator Russ Feingold (D) also confirmed the strategy of using this year's iteration of healthcare "re-form" as a Trojan Horse for a socialist single-payer system in an interview May 5, 2009 (video):

"I would love to see it, and I believe the goal here is to create whatever legislation we have in a way that could be developed into something like a single-payer system."

Single-payer proponent and congressman, Barney Frank (D), acknowledges that the public "option" is a Trojan Horse in this July 27, 2009 video:

Socialized Healthcare Supporter: "Don't you think we should scratch everything and start anew with single-payer?"

Frank: "No."

Socialized Healthcare Supporter: "Why not? ...Why shouldn't we start with single-payer anew?"

Frank: "Because we don't have the votes for it. I wish we did. I think, if we get a good public option, it could lead to single-payer, and that's the best way to reach single-payer. Saying you'll do nothing until you reach single-payer is a sure way to never get it..."

Socialized Healthcare Supporter: "Right now there's not a strong public option, is there?"

Frank: "We don't know what the plan is. I'm for a strong public option. I think your strategy is suicidal for trying to get the single-payer. The best way we're going to get single-payer, the only way, is to have a public option and demonstrate its strength and its power."

Health and Human Services secretary Katherine Sebelius now denies the public "option" is the path to socialized healthcare according to a June 2009 AP interview:

"The notion that a public option 'is really the stalking horse' for a government-run system 'is not accurate,' Sebelius said."

But Sebelius, like Obama in 2007, outlined the gradual path to single-payer universal healthcare in this 2007 video:

“I’m all for a single-payer system…eventually"

Our political doctors have slipped on their rubber glove, and while they may start with a finger, soon it will be a fist.

Remember, it's for your own good.

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[1] Patients United Now, “The Public Plan Deception—It’s Not About Choice” video: (accessed 24 Nov 2009 at http://www.youtube.com/watch?v=zZ-6ebku3_E )

Watch the video and decide what you think Hacker is saying. Hacker acknowledges that the public "option" will lead to single payer socialism while he shills for his brainchild (pdf). He supplies the talking points that "re-form" proponents use, and believes that Medicare, one of the reasons the Obama administration is so hot to regulate healthcare costs is working well:

"The idea of a public insurance plan goes back very far, and the Medicare program, of course, embodies that ideal. In 1965, the United State decided that for America's elderly, and later for America's disabled, there would be a public health insurance plan available regardless of income or medical conditions. And that plan is enormously popular today, to the point that many Americans, it seems, aren't fully aware that it's a government insurance plan, because it works so well they just can't believe the government actually gets things right."[2]

Hacker says he was taken out of context in footnote 37 of PUBLIC PLAN CHOICE IN CONGRESSIONAL HEALTH PLANS: THE GOOD, THE NOT-SO-GOOD, AND THE UGLY, By Jacob S. Hacker, Ph.D., Aug 20, 2009, (accessed 24 Nov 2009 at http://www.metaglyfix.com/jsh/pdfs/Hacker_Public_Plan_August_2009.pdf):

"However, when a small firm decides to purchase coverage through the exchange, they are in effect buying group health insurance for their workers. If firms believe their workers would have access to better options through the exchange, why should they not be able to buy coverage for their workers through it? After all, employers who enrolled their workers in the exchange would have to pay the same share of the premium that they would have to pay if they purchased coverage outside the exchange, so the main attraction of going into the exchange for employers would be to obtain better value group health plans, including the public plan.37"

"37 Lately, comments I made at a 2008 forum have been taken out of context to suggest that public plan choice is a stealth strategy of eliminating private insurance. This is nonsense: I developed the public plan idea as an alternative to “Medicare for All” (see Hacker, Jacob S., “Fixing the Left’s Health Care Prescription,” Slate, 10 October 2006, accessed at http://www.slate.com/id/2151269/?nav=tap3), as well as a competitive alternative to private insurance that would compete on a level playing field with private plans within a new national insurance exchange (see Hacker, supra note 6). I do not believe that a new public plan will evolve into a single payer system. My aforementioned comment at the 2008 event was that the new public plan is not a hidden “Trojan Horse.” The public plan is right out in the open, as it should be, since most Americans say they want the choice of a new public plan. While I believe that we should move over time toward a system in which lower-wage workers and the employees of small firms—who are not served or ill-served by the private market today—have access to a more stable set of public and private insurance options, I have always contended that most higher-wage workers and large employers will continue to be covered by employment-based plans. As I wrote in my proposal, “The main reason why Health Care for America is comparatively inexpensive [with regard to new federal spending] is that higher-wage and larger employers would continue to offer qualified coverage privately. For large employers with higher payrolls, private employment-based coverage would remain a good deal—especially since this proposal would not eliminate the tax-favored status of private coverage. For employers not enjoying the administrative economies of large-group purchase or with lower payrolls, the Health Care for America Plan [offering the new public plan and private plans] would be the better option. Thus, most of the new federal spending would be targeted on those firms and workers least capable of providing or obtaining insurance today.” (Hacker, Jacob S., “Health Care for America,” EPI Briefing Paper #180, 11 January 2007, accessed at http://www.sharedprosperity.org/bp180.html.)"

[2] "Inventor of the public option explains why it's crucial," Alex Koppelman, Salon, September 9, 2009, (accessed 24 Nov 2009 at http://www.salon.com/news/feature/2009/09/09/public_option/index.html).