Between the Waves: Building Power for a Public Option.

Hacker, Jacob S

Given the close division of power in D.C., how might health reformers pursue their bolder aims? In particular, how might they pursue the robust public option that is a centerpiece of Joe Biden's reform proposal? This ambitious plan, which would allow all Americans to enroll in subsidized public health insurance, is not in the cards right now. However, I argue for conceiving of it as an inspiring vision that can structure immediate initiatives designed to make its achievement more feasible. First, I explain just how far-reaching the mainstream vision of the public option now is. Second, I describe a self-reinforcing path to that endpoint that involves what I call "building power through policy"-using the openings that are likely to exist in the near term to reshape the political landscape for the long term. This path has three key steps: (1) pursuing immediate improvements in the ACA that are tangible and traceable yet do not work against the eventual creation of a public option; (2) building the necessary policy foundations for a public option, while encouraging progressive states to experiment with state public plan models; and (3) seeding and strengthening movements to press for more fundamental reform.