Public Options and Death Panels: How the Health Care Debate Evolved

March 23, 2012 -- In October of the 2008 presidential campaign, Barack Obama and John McCain took a question at a town-hall debate on whether health care is a privilege, a right, or a responsibility for Americans.

Obama's answer foretold one of the most dominant conversations of the next four years of his life:"I think it should be a right for every American," Obama said.

After years of countless contentious town halls across the country, backroom negotiations, speeches, compromises, advertisements and spam emails, the Great Health Care Debate has split the United States along party lines and is likely to be one of the more important matters for voters on Election Day 2012.

Next week, the Supreme Court will hear oral arguments on the constitutionality of the health care law's "individual mandate," the provision that requires people to have health insurance or to pay a penalty.

So how did we get here?

The 2008 Campaign

Actually, go back further.

The Clinton Administration

Bill Clinton tried to pass health care "reform" in 1993, an effort tied closely to his wife, future senator/presidential candidate/Secretary of State Hillary Clinton. He famously used a prop before a joint session of Congress, holding up a card and saying that all Americans would get such a card to guarantee health benefits for life. (Kind of like the Social Security card.)

Teddy Roosevelt was actually the first president who tried to oversee national health reform. But like Clinton, he couldn't get his plan through Congress.

The 2008 Campaign

Barack Obama and Hillary Clinton both want to make health care more accessible for all Americans. John McCain does, too, but the Democrats say their plan is more realistic. Obama expresses support for what's called the "public option," basically government-sponsored health care. (He gives up on it later on.)

Health care becomes a big issue in both the primary and the general election. That's why Tom Brokaw asked Obama and McCain at that town hall whether health care is a privilege, a right or a responsibility. Obama's promise is basically that he'll try to make health care better, in general terms.

One hiccup for Obama that will return to haunt him is that while he campaigns, he opposes the "individual mandate" — the very provision in the current law that is at stake in the Supreme Court case.

The First Days

Obama wins and becomes president. His health care plan is essentially a collage of ideas that have been around for a while, all cobbled together. But because the plan has no key defining factor, it's hard to sell to the public. Republicans use this opportunity as a chance to say it's a government takeover of health care.

"It's still the case that, not surprisingly, the majority of the public has no clue about what the bill actually did," says Mark Schlesinger, a professor at the Yale School of Public Health.

A few parts of the plan are really popular – like getting rid of "pre-existing conditions," clauses and letting young people stay on their parents' plans for a few more years. When polled, people generally say they like those things, and some bigger parts of the bill, too. But when they're asked if they like the bill as a whole, many say no. This upsets the White House.

The Death Panels