Yale University professor Jacob Hacker, a nationally recognized figure known as the "father of the public option," believes the passage of legislation in 2010 was the "easy part" of reforming health care in the United States, and during his March 31 visit to Elon University he explained the challenges that remain in making sure all Americans have access to health insurance while reducing overall medical costs.
Hacker spoke in Whitley Auditorium as the latest speaker in the James P. Elder Lecture Series. His remarks were followed by questions from audience members, many of whom probed his opinion on how costs can be brought under control and on possible alternatives to President Barack Obama’s controversial initiative.
“Americans have very limited understanding of what the bill is, and I don’t blame them. It’s very complex,” Hacker said during his talk. “Almost all the key provisions of the legislation, except the requirement that you have coverage, are overwhelmingly supported.”
The public likes that insurance companies won’t be able to deny coverage based on preexisting conditions, he said, and that children up to 26 can remain on a parent’s insurance policy. They also support revisions to Medicare contained in the legislation that will lower costs for seniors.
The far greater challenge to the future of health care reform implementation isn’t at the federal level, Hacker added. It’s in the states where politicians are currently grappling with how to establish health insurance exchanges for people without insurance to find policies that fit their needs. A critical element to effective reform is lacking in the law that was passed.
“It lacks the means to create a seamless source of coverage for Americans,” he said. “There’s too much emphasis on requiring people to have coverage and not enough on how to get people into coverage in the first place.”
Hacker, whose policy proposals have led him to testify before Congress and speak often to media, explained why the public option – a government-run insurance plan, open to anyone who wants it and that would compete against private insurers – is still a good idea despite being rejected by lawmakers as health care reform took shape in 2010.
Namely, he said, it’s the costs. Such a program would keep costs lower, and Hacker pointed to another government program to make his point. “Spending on the elderly is growing much more slowly than spending on those under 65,” he said. “The reason is that Medicare has done a much better job of controlling costs.”
Hacker emphasized that effective health care reform is crucial for leveling the playing field for Americans who work hard yet, through bad luck, find themselves financially burdened by medical expenses.
“Health care remains in some ways a great untapped frontier,” he concluded. “In addressing health care and in trying to being down costs over time and to make sure people have coverage that provides protection if they or a member of their family gets sick, in doing that, we’re pushing that frontier back and creating a broader promise for the ‘American Dream.’
“This fight is really not just about what’s going to happen with the Affordable Care Act. It’s really about the American Dream and whether or not, and how, we deliver on that age old promise … on the idea that if you work hard and play by the rules, you’ll have a decent chance at success.”
Hacker is the Stanley B. Resor Professor of Political Science at Yale University and a Resident Fellow at the Institution for Social and Policy Studies. He is also a Fellow at the New America Foundation in Washington, D.C., and a former Junior Fellow of the Harvard Society of Fellows.
An expert on the politics of U.S. health and social policy, he is author of The Great Risk Shift: The New Economic Insecurity and the Decline of the American Dream, The Divided Welfare State: The Battle over Public and Private Social Benefits in the United States, and The Road to Nowhere: The Genesis of President Clinton’s Plan for Health Security, co-winner of the Brownlow Book Award of the National Academy of Public Administration. He is also co-author, with Paul Pierson, of Off Center: The Republican Revolution and the Erosion of American Democracy and has edited two volumes—most recently, Health At Risk: America’s Ailing Health System and How to Heal It.
Hacker’s scholarly articles have appeared in such outlets as The American Political Science Review, The British Journal of Political Science, Health Affairs, The New England Journal of Medicine, Perspectives on Politics; Politics & Society, Studies in American Political Development, and The Journal of Health Politics, Policy, and Law. A frequent media commentator, Hacker has testified before Congress, advised leading politicians, and written popular pieces for the American Prospect, New Republic, Nation, New York Times, New York Times Magazine, Los Angeles Times, Washington Post, Boston Globe, Boston Review, and other publications.
He is the author of a 2007 proposal for universal health care, “Health Care for America,” that became a template for several presidential aspirants’ plans, as well as of two recent briefs on how and why to encourage private health insurance to compete with a new public health plan for the non-elderly.
Hacker took a moment before his address to praise Elon for its values and for the lecture’s namesake.
“I’ve heard so much about the university and am inspired by its mission and its agenda,” Hacker said. “I’m privileged to be representing professor Elder, who I didn’t know but who I had the privilege of meeting earlier today. He’s a remarkable man, as you can tell by the fact that there’s a lecture created in his name.”
The James P. Elder Lecture is Elon’s first endowed lecture series devoted to the exploration of critical scholarship and its impact in the public forum.
Elder graduated from Elon in 1960. He founded the Liberal Arts Forum as an undergraduate in 1958, and went on to serve on the history faculty at Elon from 1963 to 1973. As faculty adviser to the Liberal Arts Forum, he helped bring more than 150 distinguished lecturers from major universities to the Elon campus. He was instrumental in the creation of Elon’s study abroad program.
Five times during his tenure, Elon students voted him as the college’s Outstanding Professor.