At the Intersection of Health, Health Care and Policy

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Helen A. Halpin and Peter Harbage

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The Origins And DemiseOf The Public Option
Health Affairs 29, no.6 (2010):1117-1124
doi: 10.1377/hlthaff.2010.0363

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 History & Politics

By Helen A. Halpin and Peter Harbage

doi: 10.1377/hlthaff.2010.0363

The Origins And Demise

HEALTH AFFAIRS 29,
NO. 6 (2010): 11171124
2010 Project HOPE
The People-to-People Health

Of The Public Option Foundation, Inc.

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Helen A. Halpin (helenhs@
ABSTRACT The public option for health insurance, as defined by the berkeley.edu) is a professor at
111th Congress, grew from roots planted in California in 2001. the School of Public Health,
University of California,
Progressives supported it as a voluntary transition toward single-payer Berkeley.
insurance, while conservatives opposed it as a government takeover of
Peter Harbage is a consultant
health care. Although present in several interim bills and in legislation with Peter Harbage
passed in November 2009 by the House of Representatives, the public Consulting, in Washington,
D.C.
option was omitted from the legislation passed by the Senate in
December 2009 and from the final package adopted by both houses in
March 2010. Lack of support among moderate Democrats, opposition
from Republicans, and ambiguous messages from the White House are
among the explanations for the public options defeat. However, there is
nothing in the recently enacted legislation that would prohibit states
from creating a public option in their exchanges.

A
s the 111th Congress drafted legis-
lation for comprehensive health
care reform, the proposal to offer
Americans the choice of a so-called
public option became one of the
most hotly contested issues. From the beginning
there was confusion, not only over what consti-
tuted a public option, but also what it would
mean to the U.S. health care system and the
American people. The public option raised the
long-standing question: What is the appropriate
role of government in achieving health insur-
ance coverage for all Americans?
We trace the rise and fall of the public option,
as it came to be defined in the recent health care
reform debate, and as experienced by two pro-
ponents intimately involved in the process. We
recount the public options emergence in Cali-
fornia in 2001 and 2002 and chronicle its demise
in Congress in 200910. Progressives supported
a public option as an alternative to the for-profit
health insurance industry, with expectations
that it would control costs, promote competi-
tion, and prompt delivery reforms and lower
provider charges through the bargaining power
of a large government payer.
The proposal to increase the role of govern-
ment in achieving these aims fueled the con-
cerns and opposition of conservativesas well
as those of private insurers, providers, and
other interest groups representing the supply
side of the health economy. Ultimately, the pub-
lic option failed as a result of many factors, in-
cluding lack of support from moderate and
conservative Democrats, opposition from Re-
publicans and health care interest groups, and
ultimately an absence of strong support from the
White House.
Chronology Of The Public Option
Public health insurance, in the form of Medicare,
Medicaid, and the Childrens Health Insurance
Program (CHIP), has existed in the United States
for decades, as have proposals to expand those
programs. However, the public option, which
first surfaced in 200102, represented an en-
tirely new idea. The concept was to offer a pub-

J U NE 20 1 0 2 9 :6 HEA LT H AFFA IR S 1117

History & Politics
licly insured plan in direct competition with
other options for private health insurance cover-
age, in the hope of driving down both premiums
and underlying health care costs.
Birth In California The idea of a public op-
tion within a state-based health insurance ex-
change was initially set forth in a proposal
known as CHOICE. This was part of Californias
Health Care Options Project (HCOP),1 an initia-
tive to update and develop ideas and options on
how to expand coverage in California, and was
funded by a federal planning grant to the state
Health and Human Services Agency. The
CHOICE proposal2 built on the model of man-
aged competition, with its array of competing
private managed care plans. However, it added
a new option, the public option, to the exchange,
to broaden the array of choices available to indi-
viduals and families. The public option was also
designed to compete with private plans in the
exchange and to serve as a policy compromise
between a single-payer system and managed
competition among private plans.
The CHOICE proposal was developed by a
group of health care leaders3 who convened at
the University of California, Berkeley, during
200102, under the direction of one of the au-
thors, Helen Halpin (Schauffler). Under the
CHOICE proposal, nonelderly Californians could
enroll in the private managed care plans or the
new public option offered through the exchange.
CHOICE would allow any willing licensed health
care provider to participate in the public plan,
and would pay providers Medicare rates. It was
designed to grow the pool of people purchasing
in the exchange as quickly as possible.
The Lewin Group4 assessed the impact of
CHOICE on coverage and costs. Its analysts pre-
dicted that within one year of its enactment,
64 percent of Californians would elect to get
coverage through the exchange, with approxi-
mately 32 percent of them (more than eleven
million) enrolling in the public option.
In 2003, CHOICE in California served as the
basis for a national reform proposal published in
the Robert Wood Johnson Foundations Cover-
ing America Series, Getting to a Single Payer
System Using Market Forces: The CHOICE Pro-
gram.5 The national CHOICE proposal gave
each state responsibility for administering a
new insurance exchange, contracting with man-
aged care plans, and creating and administering
a new public plan. However, the CHOICE pro-
posal was not immediately embraced at the state
or federal level, and it would not reemerge until
the 2008 presidential campaign.
The Presidential Primaries John Edwards
was the first Democratic presidential candidate
in the 2008 election to release a health reform
1118 H E ALTH A FFAI RS J UN E 2 0 1 0 2 9: 6
proposal; he did so in February 2007.6 His pro-
posal encompassed the principles of CHOICE,
with each state creating a health insurance ex-
change offering competing private plans as well
as a new public plan option. Individuals and
employers could elect to purchase insurance
through the exchange.
Edwards saw the public option as a potential
transition to single-payer insurance. In discus-
sing the public option, he stated: American
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consumers will decide what works best. [A
marketplace where private insurance competes
with government plans] could continue to be
divided. But it could go in one direction or the
other, and one of the directions is obviously
government or single payer. And Im not op-
posed to that.7
At least three factors were behind the Edwards
proposal. First, the candidate said that he be-
lieved there was a legitimate and strong argu-
ment for a single-payer plan, but he also under-
stood that many Americans like the health care
they have and are nervous about entirely
government-controlled health care.7 Second,
Peter Harbage, a longtime health care adviser
to Edwards and the other author of this paper,
had served as assistant secretary for health in
Gov. Gray Daviss administration in California
between 2001 and 2003. It was the Health and
Human Services Agency under the Davis admin-
istration that oversaw the grant under which
the CHOICE proposal was developed. Third,
Harbage went on to serve as the senior health
policy adviser to the Edwards presidential cam-
paign from 2003 to 2008, and he continued to
voice support for the basic principles and frame-
work of CHOICE.
The Edwards campaign released its plan two
weeks after another public plan proposal8 was
put forward by Jacob Hacker of Yale University.
Hackers proposal, built on his 2003 plan for
expanding Medicare,9 would have created a
federal Medicare-like public plan through
which individuals or employers could purchase
coverage.
The public plan Hacker envisioned was struc-
tured differently from CHOICE and did not em-
brace the state-based managed competition
model that was the foundation for the public
option in the CHOICE and Edwards proposals.
Hacker went on to became one of the strongest
proponents of the public option, contributing to
the policy discussion through writing and advo-
cacy as a professor at the University of California,
Berkeley, and in partnership with the Campaign
for Americas Future.10,11 His advocacy proved
important in advancing the idea of the public
option among key Democratic constituencies.
The health care reform proposals developed by
the campaigns of Barack Obama12 in May 2007
and Hillary Clinton13 in September 2007 also
included health insurance exchanges with a pub-
lic option. The Obama team became aware of the
CHOICE model in April 2007.14 Shortly therafter,
Halpin joined the Obama campaigns health pol-
icy committee.
The three leading Democratic candidates ver-
sions of the public option were quite similar.
They varied primarily with respect to who was
eligible to purchase through the exchange, and
whether the exchange was administered at the
federal or state level.
The Path Through Congress Following
President Obamas inauguration in Janu-
ary 2009, the U.S. Congress began its work on
comprehensive health care reform. House
Speaker Nancy Pelosi (D-CA) pledged at the time
that the House bill would include a public op-
tion.15 Indeed, a public option offered through
a private insurance exchange was included in
all three versions of the bill passed by House
committees in the summer of 2009 (House Ways
and Means and House Education and Labor on
17 July 2009; House Energy and Commerce on
31 July 2009), as well as in the bill passed by the
full House of Representatives on 7 November
2009 (the Affordable Health Care for America
Act, HR 3962). A public option was also included
in the bill passed by the Senate Health, Educa-
tion, Labor, and Pensions Committee on 15 July
2009 (the Affordable Health Choices Act,
S 1679).
Senate Democrats were engaged in a highly
contentious debate throughout the fall of
2009, and the political life of the public option
changed almost daily. The debate reached a criti-
cal impasse in November 2009, when Sen.
Joseph Lieberman (I-CT), who usually caucuses
with the Democrats, threatened to filibuster the
Senate bill if it included a public option.
During this period, several alternatives were
considered. One compromise proposal included
a Medicare buy-in for people age fifty-five and
older. However, both Senator Lieberman and
Sen. Olympia Snowe (R-ME) opposed the Medi-
care buy-in, which evoked concerns similar to
those raised about the public option. Sen. Kent
Conrad (D-ND) proposed using nonprofit health
care cooperatives to compete with for-profit
plans, but this concept also sparked little en-
thusiasm.
Debate over the public option continued as
additional proposals were made to narrow eli-
gibility for the public option and to raise the rates
paid to providers above Medicare levels. When
those, too, failed to garner enough support,
the public option was eliminated from the Senate
bill.
Sen. Charles Schumer (D-NY) and Sen. Jay
Rockefeller (D-WV) made last-minute attempts
to introduce amendments to include a public
option as the bill was about to be voted on by
the Senate Finance Committee. Those failed, and
there was no public option in either the bill that
emerged from that committee or the bill that
passed the full Senate on 24 December 2009
(the Patient Protection and Affordable Care
Act, HR 3590). The option was also omitted from
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the presidents proposal, Principles for Health
Reform, released 22 February 2010 prior to a
bipartisan health care summit. Likewise, it was
not present in the budget reconciliation bill
passed by the House and Senate and signed into
law by President Obama in March 2010.
Public Option: Benefits And Risks
The broken U.S. health care system, and the
practices of the for-profit health insurance in-
dustry, provided the rationale for many Demo-
crats to support a public option in 2009. Many
believed that regulation alone would not be ef-
fective in reining in the anticonsumer practices
of private insurance companies. Public-option
proponents argued that the market needed to
be reformed from the inside out, by creating a
new choice for consumersmany of whom did
not want to be mandated to purchase health in-
surance in a for-profit marketplace.
Impact On Health Care Markets Proponents
argued that a public option would have a major
impact on the structure of the U.S. health care
market.16 They believed that it would create a
more competitive marketplace, particularly in
states with few insurance options.17 It was also
hoped that the public option would help keep
private insurers honest.18 If consumers felt mis-
treated by private insurance, they could vote with
their feet and choose the public option. Eco-
nomic theory suggests that fear of market loss
would motivate private insurers to change their
behavior. Opponents of the public option, how-
ever, feared that private plans could not compete
against it and that, over time, it would erode both
the individual and group health insurance
markets.
Impact On Accountability The public option
was also designed to increase accountability in
health insurance.19 By definition, it would be
accountable to elected officials. This represents
a fundamental difference from for-profit health
insurance, with its fiduciary responsibility torn
between policyholders who need medical care
and stockholders who expect a return on equity.
Impact On Costs There was broad agreement
among supporters that the public option could
contain costs.20,21 By creating a large, new health
JUNE 2010 29:6 H E ALT H AF FAI RS 1119
History & Politics
care purchaser, proponents believed the public
option could be effective in negotiating reduced
unit costs. They also argued that the lower ad-
ministrative costs of a public plan would mean a
greater proportion of health care dollars would
go toward paying for medical care.21
There was strong disagreement, however, over
the degree to which a public option would affect
costs. Estimates varied considerably according
to the plan design evaluated and the estimators
vantage point. For example, the Congressional
Budget Office (CBO) studied both the original
House bill, which offered a public plan that
would pay Medicare rates plus 5 percent, and
the House Energy and Commerce Committee
bill, which featured negotiated rates. The CBO
analysis found that the Medicare ratebased plan
would save $110 billion over ten years, versus
$25 billion under negotiated rates.22 Conserva-
tives, on the other hand, argued that the public
option would end up costing more than it col-
lected from policy holders and thus would even-
tually balloon the deficit.23
Role Of Government What progressives saw
as the benefits of a public option, conservatives
saw as its flaws. Expanding governments role as
a payer through a public option was framed by
conservatives as a move toward socialism.24 In
addition, medical care providers feared that a
larger government role would lead to low
payment rates, expanded rate setting, and
government control over health care, regardless
of the structure of the public option.
The opposing views held by supporters and
opponents contributed to the outsize debate
around the public option, which often eclipsed
other important issues in health reform. After
all, the pros and cons of the public option could
be condensed into sound bites about taking on
big insurance companies or a government
takeover of health care in a way that the complex
issues of health care financing could not. And at a
time when other major effortssuch as the bail-
out of Wall Street and the federal stimulus bill
were perceived as having expanded the role of
government, the press and public were open to a
narrative about the dangers of big government in
health care. In retrospect, the nature of the de-
bate over the public option was somewhat pre-
dictable, given the circumstances.
Issues In Policy Design
For the most part, the basic characteristics of the
CHOICE model for the public option5 remained
in place as the idea was discussed and developed
throughout 2009. However, disagreements
among its supporters came to define the substan-
tive policy debate. There were three central ques-
1120 H E ALTH A FFAI RS J UN E 2 0 1 0 2 9 :6
What progressives
saw as the benefits
of a public option,
conservatives saw
as its flaws.
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tions: how much to pay physicians and hospitals;
whether there should be a single, federal pur-
chaser or a number of smaller state or regional
purchasers; and how to determine eligibility for
purchasing in the exchange. Both sides of the
debate suffered from a lack of data to make their
points, with ideology often trumping analysis
and opinion offered in lieu of evidence.
Use Of Medicare Rates The Medicare-like
approach would have tied payments to Medicare
reimbursement, with proposals for using
100 percent or more of Medicare rates.5,8,25 Those
who supported using Medicare rates focused on
the potential to lower costs. Opponents, on the
other hand, were concerned about unintended
consequences. Some economists feared that
Medicare rates would lead to cost shifting and
reduced access to care, with few providers
willing to accept low Medicare payments.20,26
With Medicare rates already leaving tight mar-
gins for providers, many of them feared for their
future financial viability.
Federalism There was also disagreement over
whether the public option should be one na-
tional plan or a number of state or regional
plans. Many resisted the idea of a national in-
surance pool, which struck them as big gov-
ernment, while supporters said that a national
approach would reduce administrative costs and
was necessary to create a strong price negotia-
tor.8,11 Those seeking a state or regional approach
viewed the potential market strength of a na-
tional plan as something to be feared, primarily
because it might lead to national rate setting.24
They were also concerned that states would have
no control over how the insurance exchange and
public option were designed, and they argued
that each state or region was best positioned
to meet the needs of its constituents and design
the options to fit its market.5
Eligibility Another design issue concerned
eligibility for the exchange. The more people
who were eligible to purchase in the exchange,
the larger the risk pool would be, and the greater
the potential savings. However, there was never
a shared understanding of how big might be
too big.
In most of the bills, individuals who were not
eligible for either existing public or employer
insurance would have been eligible to purchase
through the exchange and to have the choice of
the public option. The differences across bills
related to how much access to give employers.
Most bills included provisions for small employ-
ers to move their workers into the exchanges,
with some proposals phasing in eligibility over
time based on firm size. Other proposals would
have enabled any employer, regardless of size, to
move workers into the exchange or simply let
each worker decide.
The issue boiled down to how important it was
to preserve the employer insurance market.
Clearly, the small-group market was not serving
small firms well, and new options for them were
a priority. But for those who wanted to see the
public option succeed and attract a large, stable
risk pool, it was important to open the exchange
to anyone with employer coverage. This side
feared that limiting eligibility could lead to ad-
verse selection into the public plan, threatening
its long-term viability.27 In contrast, others were
worried that opening the exchange to large em-
ployers would cause many of them to stop pro-
viding coverage, thereby breaking the pledge
that people who were happy with their current
coverage could keep it.
The CBO estimated that only eleven to twelve
million Americansless than 5 percent of the
populationwould enroll in the public option
under the House bill, which restricted employ-
ers eligibility for exchange participation. In con-
trast, the Lewin Group estimated that the
number of enrollees in the public option could
be as high as 100 millionapproximately 32 per-
cent of the populationif workers for all firms
were allowed to purchase insurance through the
exchange.28
The Politics Of The Public Option
The public option was the darling of the pro-
gressive wing of the Democratic Party. It also
proved to be surprisingly resilient and popular
among the public, as measured in opinion
polls.29,30 The strongest supporters included pro-
gressive interest groups led by labor unions
most notably the AFL-CIO and SEIUconsumer
groups, and civil rights organizations. The
strongest opponents were the health care and
health insurance industries, conservative inter-
est groups, and small businesses represented by
the Chamber of Commerce and the National
Federation of Independent Businesses.
Unlike the Republicans, who remained unified
in their opposition, the Democrats split. Ideo-
logical divisions between progressive and more
moderate Democrats made progress in Congress
difficult, despite majority-party status. Speaker
Pelosi was able to pass legislation with a public
option in November 2009, notwithstanding con-
cerns from conservative Blue Dog Democrats.
However, Senate Majority Leader Harry Reid
(D-NV) was never able to find the support of
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sixty senators required to prevent a threatened
Republican filibuster. The Democratic senators
who expressed the greatest concern were from
more conservative states, such as Arkansas and
Louisiana.
The Public Debate As conservatives framed
the public option as socialism,23 claims of a
government takeover of health care captured
the attention of the mainstream media, nearly
excluding coverage of the policy debate taking
place. Republican opposition grew directly out of
a stated desire to limit the role of government in
health care and a fear that even a weak public
option would provide a foundation for further
expansion of the governments role in health
care.31
Support for the public option was equally fer-
vent. The former Vermont governor Howard
Dean, through Moveon.org, Democracy for
America, and Health Care for America NOW!,
along with Richard Trumka, president of the
AFL-CIO, orchestrated a national campaign for
the inclusion of the public option in health re-
form. In March 2009, Dean, Trumka, and the
organizations they worked with drew a line in
the sand, indicating that any bill that did not
include a public option was not real reform.32 The
political action thus mobilized was successful in
persuading more than 400,000 group members
across the country to sign a petition and to con-
tact their members of Congress in an appeal to
preserve the public option.33
Within The White House Opinion regarding
how best to approach health care reform, includ-
ing the public option, appeared to be split inside
the White House.34 As a result, many supporters
of the public option faulted President Obama for
not pushing the concept more forcefully. One of
the earliest signs that the public option was a
negotiable item for the administration came in
July 2009, from Rahm Emanuel, the White
House chief of staff. Emanuel floated the idea
of a trigger that would enable the public option
only if the desired competition and cost control
failed to materialize.
During the congressional recess in Au-
gust 2009, at the height of the town hall push-
back against health reform, other adminis-
tration voices began to downplay the importance
J UN E 2 0 1 0 2 9: 6 HE A LT H A FFA IRS 1121
History & Politics
of the public option.35 The secretary of health and
human services, Kathleen Sebelius, said that the
public option was not the essential element for
reform.35 President Obama stated at a town hall
meeting: The public option, whether we have it
or we dont have it, is not the entirety of health
reform. This is just one sliver of it, one aspect
of it.35
Ambiguity inside the White House sprang
from several sources. Foremost was the White
Houses desire to try to forge a bipartisan bill.
By the fall of 2009, some of the Senates moder-
ate Democrats had moved to support a drasti-
cally curtailed public option without ties to
Medicare and only as a trigger, while Republi-
cans remained uniformly opposed to the idea.
Sen. Max Baucus (D-MT), chair of the Senate
Finance Committee, spent months trying to
forge a bipartisan bill with a subgroup of his
committee, but he ultimately could not secure
a single Republican vote.
It has been suggested that the White House was
employing a negotiating tactic in being inten-
tionally vague about its support for the public
option.36 By remaining vague, the president was
able to perform a necessary balancing act, sat-
isfying his progressive base without threatening
more-moderate Democrats. Indeed, when pre-
sented with critical opportunities to draw a line
in the sand in support of the public option, or to
even offer policy details, the president did not
take them.37 Knowing that Senate support for the
public option was weak, President Obama did
not put himself out in front on this issue, lest
he threaten his ability to enact any reform in the
process.38
The End Game: Reconciliation In Febru-
ary 2010, when the House and Senate were ne-
gotiating a budget reconciliation bill to amend
the Senate health care reform bill and pave the
way for final passage, yet another political
scramble over the public option ensued. A letter
authored by Sen. Michael Bennett (D-CO) called
for a vote on the public option through budget
reconciliation.39 The letter was eventually signed
by forty Senators, just ten shy of the needed fifty.
But after all was said and done, the leadership in
both the House and the Senate were more com-
mitted to passing a bill than to keeping the public
option alive.
On 12 March 2010, as she prepared for her
1122 H E ALTH A FFAI RS J UN E 2 0 1 0 2 9 :6
Leadership in the
House and the Senate
were more committed
to passing a bill than
to keeping the public
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option alive.
final push to pass reform legislation, House
Speaker Pelosi shut the door on using reconcilia-
tion to preserve the public option. While citing
the lack of support in the Senate, Pelosi was also
aware of the deep concerns that moderates in her
caucus had regarding the public option. The nar-
row vote (219212) in the House on 21 March
2010 suggests that every possible vote was
needed. The House passed the Senate bill
(HR 3590) and the reconciliation bill without
a public option.
Conclusion
It is difficult to recall a federal health policy pro-
posal that has seen such dramatic ups and downs
as the public option endured. There were clearly
wild swings in both the hopes and fears attached
to it, and its death and rebirth were proclaimed
repeatedly over the course of a long process of
debate.
Even though comprehensive health care re-
form has been enacted without a public option,
the proposal could reemerge if the public be-
comes dissatisfied with the progress of health
reform. A more likely venue for rebirth, however,
is adoption at the state level. States could choose
to create a public option today, and there is noth-
ing to stop a state from offering one in its new
insurance exchange. If and where any of these
possibilities play out will depend on the political
climate in individual states, with heavily
Democratic states the most likely places for a
renewed debate.
NOTES
1 Health Care Options Project: 9 Pro-
posals for Health Care Reform in
California. Federal HRSA State
Planning Grant to the California
Health and Human Services Agency.
2001 Feb.
2 Schauffler HH. CHOICE. California
Health Care Options Project. Sacra-
mento (CA): Health and Human
Services Agency; 2002 Mar.
3 The CHOICE team in 20012 in-
cluded Helen Halpin (Schauffler),
Center for Health and Public Policy
Studies, School of Public Health,
University of California (UC),
Berkeley; Sara Singer, Health Policy
Center, Stanford University; Dean
Emeritus Joyce Lashof, School of
Public Health, UC Berkeley; Patricia
Powers, Pacific Business Group on
Health; Sharon Levine, Kaiser Per-
manente Medical Group; Sylvia
Guendelman, School of Public
Health, UC Berkeley; and Sara
McMenamin, School of Public
Health, UC Berkeley.
4 Lewin Group. Cost and coverage
analysis of nine proposals to expand
health insurance coverage in Cali-
fornia. Final Report. Prepared for
the California Department of Health
and Human Services. Washington
(DC): Lewin Group; 2002 Apr 12.
5 Halpin HA. Getting to a single payer
system using market forces: the
CHOICE program. In: Covering
America: real remedies for the un-
insured, Vol. 3. Washington (DC):
Economic and Social Research In-
stitute; 2003 Oct 31.
6 Edwards 08: universal health care
through shared responsibility. 2007
Feb 5.
7 Sack K. Health care up to public,
Edwards says. New York Times.
2008 Jan 25.
8 Hacker JS. Health care for America: a
proposal for guaranteed, affordable
health care for all Americans build-
ing on Medicare and employment-
based insurance. Washington (DC):
Economic Policy Institute; 2007
Jan 11. EPI Briefing Paper no. 189.
9 Hacker JS. Medicare plus: increasing
health coverage by expanding
Medicare. In: Covering America: real
remedies for the uninsured, Vol. 3.
Washington (DC): Economic and
Social Research Institute; 2003
Oct 31.
10 Hacker JS. The case for public plan
choice in national health reform.
Berkeley (CA): Campaign for
Americas Future and UC Berkeley
Center for Health, Economic, and
Family Security; 2008 Dec 17.
11 Hacker JS. Healthy competition:
how to structure public health in-
surance plan choice to ensure risk-
sharing, cost control, and quality
improvement. Berkeley (CA): Cam-
paign for Americas Future and UC
Berkeley Center on Health, Eco-
nomic, and Family Security; 2009
Apr. Policy Brief.
12 Obama 08: Barack Obamas plan for
a healthy America. 2007 May 7.
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J UN E 2 0 1 0 2 9: 6 HE A LT H A FFA IRS 1123
History & Politics
ABOUT THE AUTHORS: HELEN A. HALPIN
Helen A. Halpin is a
professor at the
University of
California, Berkeley.
Helen A. Halpin is a professor of
health policy at the School of
Public Health, University of
California, Berkeley, where she also
serves as director of the Center for
Health and Public Policy Studies
and chair of the policy and politics
track for the Ph.D. program in
health services and policy analysis.
She received her doctoral degree in
social welfare policy from the
Heller School at Brandeis
University and her masters degree
in health policy and management
from the Harvard School of Public
Health, where she also was on the
faculty from 1978 to 1982.
Halpin was a health policy
adviser to the presidential
campaign of Barack Obama. She
took a sabbatical from Berkeley in
2008 to serve as a campaign
surrogate, speaking throughout
northern California on the
campaigns health reform
proposals. It was the most
important work that I could
possibly do at the time, she says.
She was a key intellectual force
behind the development of the
public-option proposal that became
a centerpiece of early Democratic
1124 H E A LT H A FFA IRS J UN E 2 0 1 0
& PETER HARBAGE
plans for health care reformbut
that was omitted from the final
package that Obama signed into
law in March 2010. Perhaps not
surprisingly, she says that she was
troubled over the past year as the
public-option proposal was slowly
dismantled with every incremental
decision made in the health
reform debate.
Halpin has written more than
100 policy reports and briefs;
published hundreds of papers;
crafted several book chapters; and
testified frequently before the U.S.
Senate and the California
legislature. She is currently vice
chair of public health impact
analysis for the California Health
Benefits Review Program, created
by the state legislature to review
proposals to mandate insurance
benefits and assess their likely
impact.
Halpin lives part time in France,
where she serves as a deputy editor
of the journal Public Health Reviews,
published by the lcole des Hautes
tudes en Sant Public (School of
Public Health) in Rennes. She says
that this binational perspective has
reinforced her belief that the
United States is, in many ways,
ahead in research and public health
policy. But then again, Europe is
years ahead in its social contract
with its people.
Peter Harbage is president of his
own consulting firm, Peter Harbage
Consulting, which undertakes
reports and analyses for clients
including the Robert Wood
2 9 :6
Johnson Foundation and the
Commonwealth Fund. Harbages
work focuses largely on health
reform in California, where he
previously served as assistant
secretary for programs and fiscal
Downloaded from http://content.healthaffairs.org/ by Health Affairs on September 4, 2017 by HW Team
affairs with the California Health
and Human Services Agency. He is
also a lecturer at the University of
Southern Californias School of
Policy, Planning, and Development,
as well as a frequent opinion writer
for such publications as the Los
Angeles Times and the San Francisco
Chronicle. Harbage holds a masters
degree in public policy from the
University of Michigan.
Peter Harbage is a
consultant with
Peter Harbage
Consulting.
Harbages first experience in
active health policy making came
in 1993, when he served as an
intern on the White House Health
Care Task Force under President
Bill Clinton. He went on to serve as
a senior health policy adviser to
the presidential campaigns of
former North Carolina Democratic
Senator John Edwards in 2004 and
2008. He credits Edwards as being
the candidate who did the most to
popularize the public option
during the 2008 campaign.