Amidst a recession, two wars, and a climate crisis, healthcare reform has now passed its key test in the Senate. The architect of the public option explains why this is the moment for a bill to pass.

Question: Has the urgency of the healthcare debate surprised you?

Jacob Hacker: I'm not surprised because whenever we have an economic downturn it suddenly becomes apparent how manifestly our employment base system fails America. I mean, people are losing their jobs and at the same time they are losing their health insurance. Precisely when they most need security, they feel most insecure.

So we have seen a big increase in the share of Americans who lack health insurance and the only reason that that increase has been muted in the most recent downturn is because government has stepped in, in the form of Medicaid and the Children's Health Insurance Program to soften the blow. We know that about a third of Americans are saying right now that they are worried about losing their health insurance coverage.

So, when the economy goes sour, and it's gone very, very sour recently, that really accentuates people's concerns about their security and about healthcare. At the same time, if you think about it, this has been the leading cause of Democrats, since the Great Depression, since Franklin Roosevelt thought about including health insurance in the Social Security Act back in 1935; it's the great unfinished business of the New Deal, if you will. Truman was unable to do it. Johnson just decided he would just cover the aged. Clinton, most recently, tried and failed to enact a program that would expand health insurance coverage to all or most Americans.

So, for Democrats, this is the moment. If you think about it, they've got large majorities in Congress; they have a progressive President who is committed to this cause. And it really isn't just a political cause, if you think about it, it is central to our economy performing well. President Obama, during the campaign, kept talking about change, and hope, and a new foundation being laid for our economy and healthcare is really a crucial place to begin. It drains our government of money. The federal government is going to go deeper and deeper in the read if we don't control healthcare costs. It burdens our businesses, it is hurting working families, it means that millions of Americans feel insecure, it means that our healthcare is much more costly than it should be, and it means, quite frankly, that our healthcare system performs much less well than it should. Our basic health statistics and even the statistics that are used to measure the quality of care at the high level suggests that we are really paying a price for not having system that's inclusive and that's efficient. And we need to address that.

So, I think that's why I'm not surprised. I think that the reason that it's moved so quickly is precisely that it has to. If the President had not moved quickly to enact healthcare reform in this year, I think he would really have been waiting until his second term, if he had one. Because it's the case that as the election approaches, it's going to be much harder to take on such a big issue and after a mid-term election in which the historical record suggest that the Democrats are going to lose some seats. And the way the economy is right not, the might lose a fair number of seats. After an election like that, no one's going to have the sort of urge to really take on such a big issue.

So, this is the time and this is the moment, as President Obama has often said, and I think it's remarkable but necessary that they move so quickly.

Recorded on November 9, 2009
Interviewed by Austin Allen