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Alright. Let's Talk About a Public Option With Regards to Health Care.

5 min read

I’m for Medicare for All.  However, the public option is being touted by some of the Democratic presidential candidates as the alternative to Medicare for All.  I’m not going to recount all the arguments being made against Medicare for All.  Instead, I’m going to focus on the politcal arguments being made for the public option and its history. 

Essentially, advocates for the public option offer it as a government run health insurance program for those who cannot afford private health insurance or whose employers do not provide health care coverage.

Public health insurance, in the form of Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP), has existed in the United States for decades, as have proposals to expand those programs. However, the public option, which first surfaced in 2001–02, represented an entirely new idea. The concept was to offer a publicly insured plan in direct competition with other options for private health insurance coverage, in the hope of driving down both premiums and underlying health care costs.

The groups who would be served by a public option:

There are two groups who are challenged by health insurance coverage who would find easier, or more complete access to health insurance than they had before the ACA.

  • First: People who cannot afford expensive, private insurance plans, particularly those who work for employers who don't offer health insurance as a benefit, would find a more affordable option with a public payer option.
  • Second: A public option would also help those with pre-existing conditions purchase more affordable insurance. The Affordable Care Act of 2010 (Obamacare) ensured this group could not be discriminated against by insurers. A public option that would modify or replace the ACA would need to continue this protection.
  • Another group – young, healthy people – would be served by a public option, even though they have little trouble getting health insurance anyway.

Advocates of the public option state that it would do the following:

  • It would increase competition in the health insurance marketplace.
  • The power and size of the federal government to negotiate services and prices with health care providers would at least contain costs or reduce them.
  • Administrative costs would be less than what you see with private insurers.
  • It would increase accountability.  
  • There would be portability.

The current advocates for the public option use the argument that the public option gives Americans more of a choice in the health insurance marketplace.  And because it would not eliminate private health insurance, Americans would not feel as threatened that they would lose health care access.  In other words, the public option is more politically palatable than Medicare for All, which is a single payer system.

There are just a couple of problems with that argument.

First, if you look at the fine print of the public option, it would lead to the eventual elimination of private health insurance.  The government would not be passing a law against private health insurance, but private health care insurers would not be able to compete in the long run against the power and size of the public option.  And Americans would literally vote with their feet and abandon private health insurance for a public option that was cheaper and provided the same access to health care.  In other words, we would be heading for a single payer system.

Not a bad idea, except that most of the Democratic presidential candidates who support a public option shy away from this idea.  

Second, does anyone think that the private insurers are going to accept a public option?  If you do, you were not paying any attention to the last time the public option was proposed:  the fight for the ACA.  Several “moderate” Democrats opposed the public option.  And despite his campaign promise that he was for a public option, President Obama was at best ambivalent and eventually dropped it.

The proposal to increase the role of government in achieving these aims fueled the concerns and opposition of conservatives—as well as those of private insurers, providers, and other interest groups representing the supply side of the health economy. Ultimately, the public option failed as a result of many factors, including lack of support from moderate and conservative Democrats, opposition from Republicans and health care interest groups, and ultimately an absence of strong support from the White House.

The above is from  the article by Helen A. Halpin:

Helen A. Halpin is a professor of health policy at the School of Public Health, University of California, Berkeley, where she also serves as director of the Center for Health and Public Policy Studies and chair of the policy and politics track for the Ph.D. program in health services and policy analysis. She received her doctoral degree in social welfare policy from the Heller School at Brandeis University and her master’s degree in health policy and management from the Harvard School of Public Health, where she also was on the faculty from 1978 to 1982.

Halpin was a health policy adviser to the presidential campaign of Barack Obama. She took a sabbatical from Berkeley in 2008 to serve as a campaign surrogate, speaking throughout northern California on the campaign’s health reform proposals. “It was the most important work that I could possibly do at the time,” she says.

She was a key intellectual force behind the development of the public-option proposal that became a centerpiece of early Democratic plans for health care reform—but that was omitted from the final package that Obama signed into law in March 2010. Perhaps not surprisingly, she says that she was troubled over the past year as the public-option proposal was “slowly dismantled with every incremental decision” made in the health reform debate.

The emboldened is my doing.

Proponents of the public option will argue that the politics on this issue have changed.  But have they?  Republicans do not believe in providing health care to anyone.  Republicans believe if you cannot afford health insurance, tough!  The private health insurers are not going to want any competition from the government in the form of a public option.  They know it will cut into their profits.  

This leaves it up to Democrats.  And their history on the public option is not good.  Progressives may settle for a public option in any reform of health care, but what about those moderate or conservative Democrats?  It doesn’t take many of them to sink a public option.  They did it once before.  And our corrupt campaign finance system means that some Democrats in congress are bought off by private insurers or pharmaceutical companies with a vested interest in killing the public option.

To be honest, I don’t think the politics of the public option are not going to be any easier than Medicare for All.  Republicans and private insurers are going to fight tooth and nail against the public option.  And moderate and conservative Democrats have sunk the public option before.  A public option would be a step in the right direction for delivering in access to health care, but let’s not assume that passing a public option will be a breeze compared to Medicare for All.  Both are anathema to those who do not want any change in the present health care system.

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