Like most progressives, I support the public option. In this most unlikely moment, it appears that the public option may have a fighting chance. Democrats have managed to secure backing by 34 Senators willing to support a public option in reconciliation. It is still a long haul to get to 50. But for the first time since the 21st century version of massive resistance began, there is some hope that American lawmakers will offer a public insurance plan capable of competing with private insurers.
The public option is the most effective tool to control costs and the most substantive health care reform available in this political environment. But the history of public education offers some cautionary lessons that should temper our enthusiasm and encourage us to move forward thoughtfully as we advocate for a public option.
Up until the 1840s, the American system of education was not unlike the current health care system. It was rigidly localized and available primarily to the wealthy. Efforts to create national mandates for primary education were met with virulent opposition. As in the current health care debate, religiously fueled anxiety about an overreaching government formed the basis of opposition to public education. The greatest resistance to public education was mounted by Southerners who abhorred the idea of taxation, particularly if those taxes supported education for children of the formerly enslaved.
But progressives who understood the critical importance of primary education mounted a 50-year effort to convince Americans that public education for all children was central to the national interest. Reformers argued that a public option and a national mandate were crucial to creating an informed, productive, self-sustaining citizenry.
Many of their arguments mirror those of today’s health care reformers: health care access and health outcomes are marked by wealth and status; the nation’s productivity and economic future are threatened by these health inequalities; only mandates and public options will create enough change to dramatically alter the crisis.
By 1918 all states had passed compulsory elementary education laws. It is now easy to see that the public education system resulting from these 19th century battles was critically important to ensuring that America was a competitive and modern nation in world affairs. Public education dramatically improved literacy, worker productivity, entrepreneurship and social mobility.
But the public option in education also offers important lessons about the likely limits of a public option in health care. From its inception, public education poorly served the needs of girls, African Americans and immigrant children.
In many states the education of girls was not mandated until decades after boys began receiving public education. Even after schools were opened to girls, co-educational classrooms often poorly served their needs. Similarly, the current health care reform proposal extends coverage to millions of Americans while also instituting draconian restrictions on women’s reproductive health coverage, thereby eliminating access to a crucial area of health care for women.
For many decades localities refused public education to immigrant children, especially those who were considered non-white. Today, battles continue to rage in America’s urban school systems about accommodating the needs of immigrant children.
Racism and its structural residue has been the greatest barrier to equitable public education. Once the Supreme Court demanded compulsory integration for public schools, many whites simply opted out of the public option.
Economic interests alone could not keep these families in public schools. They were willing to pay to discriminate, paying both property taxes and tuition in order to ensure their children were not marked by the stigma of the public option. Hundreds of urban and Southern public education systems collapsed when denied robust contributions across a broad and diverse public.
Right now, in Wake County, North Carolina middle class families are enthusiastically resegregating public schools. Evidence that American individualism often finds a way to trump efforts toward the public good.
Rush Limbaugh has been calling health care reform “reparations” and “a civil rights bill.” If Democrats succeed in passing a public option that is marked as inferior or assumed to be racialize,d then it may be doomed to a second-class status that makes it a poor competitor against private insurers.
We need a public option. As in the case of education, a public option in health care is likely to dramatically improve the lives of those with the fewest advantages and opportunities. Even as we enthusiastically embrace this policy, we need to learn from the continuing shortcomings of our existing public option.