As the leading Republican presidential candidates are busy offering incoherent plans that would repeal Obamacare and make the insurance landscape more confusing — Donald Trump, for instance, put out a 40-word health care platform that makes very little sense — the Democratic candidates are having a substantive debate about how to make universal health care a reality.
Hillary Clinton is reaffirming her support for a policy that’s popular among proponents of a single-payer insurance system — offering a counter to Bernie Sanders’ health care plan that may be more well-received among liberal voters than her previous platform. The positioning reflects the Democratic base’s appetite for creating a path to universal health care, a far-left stance that Sanders has staked out for himself this race.
This week, Politico noticed that Clinton’s website has been updated to include her support for the “public option,” or an alternative government-run health plan that could compete with private insurance companies. (While universal government-run health care is sometimes characterized as “Medicare for all,” the public option has been characterized as “Medicare you can buy into.”)
“Hillary has never given up on the fight for universal coverage,” her website reads. “As she did in her 2008 campaign health plan, and consistently since then, Hillary supports a ‘public option’ to reduce costs and broaden the choices of insurance coverage for every American. To make immediate progress toward that goal, Hillary will work with interested governors, using current flexibility under the Affordable Care Act, to empower states to establish a public option choice.”
“We regularly update our website with additional details on Hillary Clinton’s policy positions,” a spokesperson for Hillary Clinton’s campaign told reporters who asked about the change.
The public option was a central part of the fight to get health care reform passed during Obama’s first term — a way for liberal lawmakers to bridge the gap between the country’s private insurance market and their goal of creating a more efficient and more equitable government-run system. It was actually pretty popular among the American public at the time. However, in a serious blow to progressives, the policy didn’t end up making it into the final version of the Affordable Care Act because a handful of conservative Democrats blocked it.
As her website notes, Clinton backed the public option during her 2008 campaign. But, even as she and Sanders have sparred over how to accomplish their shared goals of achieving universal health care, it’s a policy that’s been conspicuously absent from this presidential debate so far.
Before this week, the Democratic discussion over health care was mired in a conflict between Clinton’s position to protect the status quo under Obamacare and Sanders’ more ambitious vision of creating a single-payer system (and one that offers even more generous benefits than the Medicare program currently does).
For weeks, economists and health policy experts have been debating whether Sanders’ plan is accomplishable, arguing about whether it’s too thin on details and trying to figure out if the numbers add up. Meanwhile, the Clinton campaign has positioned itself as a champion of Obamacare, arguing it’s unwise to scrap the president’s landmark health reform law altogether, and pushing for incremental changes to help cover the people who are still left uninsured. Curiously, Clinton surrogates also mounted a series of dishonest attacks against Sanders’ health plan that appeared to be designed to confuse Americans about how government-run health care works in practice — misleadingly suggesting that single-payer would leave the country worse off by causing millions of people to lose their insurance.
The conflict ultimately sharpens old battle lines between a more pragmatic and a more leftist approach to governing. But the public option, which is a potential bridge between these two camps, was left out of the conversation completely.
That choice puzzled some people in the health policy space. In mid-January, the New Republic’s Brian Beutler argued that the public option could be the policy to unite Clinton and Sanders: A way to address the progressive community’s serious desire to get closer to universal health care that’s more grounded in the reality of the current insurance market.
The state-based public option that Clinton’s updated website describes isn’t identical to the more robust federally run public option that Democrats envisioned in 2009. And, of course, it wouldn’t be politically viable under a GOP-controlled Congress. But the fact that the former secretary of state is talking about a version of the public option again — an idea that Democrats appeared to have dropped altogether in recent years — helps put a path to universal health care up for more serious debate in this presidential election.
“For progressives, it’s an important step,” MSNBC’s Steven Benen argues. “Clinton has found something bright and glittery to offer progressives, and probably general election voters, on health care. It’s about time,” Slate’s Jordan Weismann agrees.
There have been other examples of the Democratic candidates’ leftward shifts during this presidential primary season, too. Both of them are forcefully calling for progressive priorities like paid family leave and comprehensive immigration reform. And Clinton and Sanders are both calling to repeal the Hyde Amendment, a longstanding federal policy that makes abortion unaffordable for impoverished women, which is a historic first in a national election.