By Marc H. Lavietes, M.D.
The Wall Street Journal, Letters, January 29, 2020
I agree with Lanhee J. Chen (“The Myth of the ‘Moderate’ Public Option,” op-ed, Jan. 24). The notion that a public option is a moderate and therefore less destructive approach to health-care reform than a universal health-care system is false. The only efficient reform would be Medicare for All.
A public option would increase premiums for those with major illnesses. Private insurers would siphon away healthier persons from the general insurance pool by offering inexpensive but noncomprehensive plans, plans designed to appeal to those with few medical needs.
In addition, multiple-payer systems with or without a public option would perpetuate exorbitant administrative costs. For example, in 2018 Canada’s single-payer system spent $196 per person on hospital administrative costs; the U.S., $933. A single-payer system, unlike multiple-payer systems, has the power to negotiate volume discounts with the pharmaceutical and durable-medical-equipment industries.
A public option added to the current hodgepodge of private plans would be more likely to increase the overall cost of health care rather than to improve either its quality or its distribution. Only a single-payer system will truly save money. Do the math. Unexpected bills from out-of-network consultants? Gone. Exorbitant bills for generic drugs? Gone. Obviously, in a universal system added beneficiaries will bring added cost. However, in the long run these expenditures would be more than balanced by savings. This notion is confirmed by a comprehensive cost analysis of New York Health, the single-payer system now under consideration by the state’s legislature.
I agree with Lahnee Chen’s premise. We need a more universal resolution of the problem.