By Ed Weisbart, M.D.
St. Louis Post Dispatch, July 5, 2019
Shhh! Don’t tell the insurance companies (it’s a secret).
That’s the logic of the presidential candidates who are pushing a “public option,” also known as Medicare for Those Who Want It. They claim that adding a Medicare-like option onto the health insurance marketplace is an easier political lift than real Medicare for All, and that such an option would thrive in the free market and open the door for Medicare for All. Then the insurance industry would admit defeat and quietly ride off into the sunset, finally achieving what should have been done in the first place.
The fact that the insurance industry is lobbying hard for this circuitous incremental approach should tell you all you need to know.
Sadly, many of us don’t understand the choice we’re being offered. That helps them sell the idea that having more options is always better. It’s true that we need free choice of doctors and hospitals, but insurance should disappear into the background. That’s what would happen with Medicare for All; that’s not what would happen with a public option, and the difference is all-important.
We could spend the next few years passing a public option and then wait several more years to see how it works. Ten years later, we would still be playing catch-up with the rest of the industrialized world, where health care costs half of what it does here in America and yet produces dramatically better results.
Why isn’t a public option good enough?
First, it’s missing nearly all the savings of a single-payer system. Health care insurance companies operate at 15% to 20% overhead; Medicare’s overhead is 2%. We will never reach Medicare’s efficiency by keeping today’s complex insurance industry in the mix. Never. Plus, the insurance companies’ inefficiency — as high as it is — is dwarfed by the untold time and money patients, doctors and hospitals waste in dealing with those companies.
American hospitals employ one insurance-related clerk for every bed they operate. We physicians often spend half of our workday fighting insurance company barriers. We’re heartsick over seeing patients skip dosages or decline essential testing because they can’t afford them.
None of this waste disappears by adding one more insurance “option.” A public option would do nearly nothing to bring down the cost of health care.
Second, a public option would be funded by premiums and co-pays. It would essentially be another regressive tax, least affordable to those in the greatest need. Only the sickest of today’s uninsured would join, driving public-option prices up higher and becoming a “high-risk pool.” Insurance depends on a mostly healthy pool of patients to balance the sickest. Whenever you turn that on its head, it goes down in flames.
Last, a “public option” does nothing to help those who now have insurance. Millions would still have sky-high deductibles. They would still be constrained by networks that tell them which doctors and hospitals to use. They would still be forced to be on constant guard for surprise medical bills and charges, even when they go to in-network hospitals. Millions still would not have access to dentistry, eyeglasses and hearing aids.
Each of these problems would be resolved by simply passing the real Medicare for All bills, H.R. 1384 and Senate Bill 1129, featuring tax-funded comprehensive benefits with no premiums, no copays, no surprise bills and your choice of doctors and hospitals.
Both bills empower Medicare to negotiate drug prices for us. Most of the public-option bills do not.
Both Medicare for All bills would stabilize hospital finances by making sure every patient had insurance and reducing administrative burdens.
Both bills allow every American their choice of physician and hospital, without fearing that a change of jobs would mean changing insurance and searching for a new doctor.
Some worry that the adversaries of Medicare for All are too powerful. In other words, they want us to believe we can sneak our way there through a public option, as if the insurance industry will never see it coming.
The next time you hear a politician say they support Medicare for All, and that the best way to get there is through a public option, raise some of these challenges. Don’t let them derail the best solution; too many lives are at stake.
Dr. Ed Weisbart is a family physician and chair of the Missouri chapter of Physicians for a National Health Program.
