Democrats in Washington state passed the country’s first “public option” plan, but the compromises they had to make offer a lesson in the realities of health care politics in America — and, perhaps, a warning for Democrats in 2020
That points to a key takeaway from Washington's public option ordeal: Any real effort to impose a cost-containment mechanism, which is essential for any reform aimed at skyrocketing prices, will meet deep and potentially fatal resistance from the health care industry. "They fought us tooth and nail on having any kind of referenced pricing mechanism," says Sen. David Frockt, who was Cody's counterpart in the state Senate, where opponents were able to hold up a stronger measure.
But Washington has also confronted the limits of health care reform. Even with Obamacare, some 400,000 state residents, or around 5.5 percent, remained uninsured. Many are unable to afford market-rate insurance but are too well off to qualify for subsidies offered through the state‘s health care exchange.
Nor, as a practical matter, did Democrats have the money. Any state-level Medicare for All-style program would need massive federal funding, along with waivers from various federal health care rules, which wasn't likely to happen under the Trump administration. On the surface, the public option was an eminently sensible strategy. As a cost-cutting measure, it needed no revenue source. Politically, it had buy-in from legislative leaders and Inslee, who was considering a bid for the White House and eager to chalk up some “moderate” policy victories. True, some party progressives regarded the public option as too modest, but Cody and other supporters believed they could be kept on board by assurances of future moves toward "universal coverage.
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