Jacob Hacker assesses whether the President’s healthcare policy has been what the doctor ordered—and what his campaign promised.

Question: Have Obama and the Democrats delivered on their healthcare promises?

Jacob Hacker: They have delivered. President Obama, during the campaign, had a broad outline of reform. One that was relatively close to my 2007 Healthcare for America Plan, and by and large the elements that President Obama embraced during the campaign have been incorporated into the House legislation and, in a weaker form, into the Senate bills that have come forth. After all, there are two Senate bills. The Senate Finance Committee bill, and then the Senate Health, Education, Labor and Pension, or Health Committee bill. And those bills are different on some specifics. Notably, the Senate Finance Committee bill didn't contain a public health insurance option, whereas the Senate Health Bill did.

But if you take the amalgam of those two bills as sort of representative more or less of the sort of direction that Senator Reid wants to go, he too is proposing something that's very close to what Senator Obama embraced during the campaign.

President Obama has been very, I think, shrewd in letting Congress take the lead on this issue. I wrote early in the year that President Obama really had to follow three cardinal rules. He had to let Congress own this bill, he needed to stick to the broad principles and let this debate take place on Capitol Hill. I also argued that he really had to keep it simple. That he had to have a few clear, simple ways of describing what he was doing. And I also argued, finally, that if necessary, he would have to go to the budget process which allows you to get a bill through with a majority vote. And they have not foreclosed that possibility though it looks much more distant now. It looks as if that it will be possible, we hope, to pass a bill through the normal Senate process which requires 60 votes.

Now, I think he's been very shrewd to rely on Congress. I think the area where he's had the most trouble is the area of articulating a clear, simple compelling vision. And that's where I think it's interesting that he Public Health Insurance Plan has actually gotten ahead of President Obama and his White House team in some ways. I mean they talked about this during the campaign, they've said we'd like to have it, but they've also been concerned about whether it would be viable in the Senate. Olympia Snow. The maiden of our legislation—would she go for this? And what's happened as the debate has moved forward is that the Public Health Insurance Plan has taken on a life of its own politically. Americans in polls say they support it, a majority of American—a large majority of American physicians say they support it.

I'm often joking that any day now, the American Kennel Club will come out and say the majority of dogs say they support the Public Health Insurance Plan, you know, lending that all-important canine voice to the effort. But this is an area where there is a lot of support for it and Congressional Democrats have gotten very vested in it and the progressive community has gotten very vested in this idea. In part because it is clear and it is simple and it has a message. It says, "Yes, we're going to have to require that Americans have health insurance to move toward this new system we all want, but we should require that they have to get insurance from the same private insurance companies that helped get us into this mess. They should have the option, the choice, of enrolling in a public health insurance plan that competes with private insurers."

Recorded on November 9, 2009
Interviewed by Austin Allen