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Why the ‘public option’ is not a real solution to our health care woes

Public Option 2016

During the 2009 debate that resulted in passage of the Affordable Care Act, some policymakers and elected officials called for a “public option” to provide an additional source of coverage and competition. Although this provision was dropped from the final legislation, it has resurfaced periodically as premiums and deductibles have spiked, provider networks have narrowed, and insurers have quit various state exchanges.

A public option may sound appealing as a means of checking commercial health insurers, but in reality it would be a very limited policy that would offer no genuine fix for what ails our current health care system.

PNHP co-founders Drs. Steffie Woolhandler and David Himmelstein argued that “The ‘Public Option’ on Health Care Is a Poison Pill” in The Nation, predicting that it would function in much the same way that Medicare Advantage does, with commercial insurers pushing sicker and costlier patients onto the public plan and policymakers favoring the insurance industry at every turn.

PNHP’s senior health policy fellow, Dr. Don McCanne, also wrote a detailed account of why advocates should temper their enthusiasm for the public option. And PNHP has developed a table, below, that contrasts the public option with single payer. (This table can also be viewed as a PDF, here.)

Other noted health policy experts have weighed in on the insufficiency of a public option, including former Centers for Medicare and Medicaid Services Administrator Dr. Don Berwick, who testified before Congress as part of a June 2019 hearing on universal health coverage. He explained how a public option that covered only the sickest patients would be a gift to commercial health insurers.

The Affordable Care Act, despite its gains, is clearly insufficient to address our most urgent health care needs, and adding yet another layer to our already fragmented system is not the answer. To learn more about a system that would improve efficiency, equity, and affordability – a single-payer national health program – please click here.

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  • About PNHP
    • Mission Statement
    • Board and Staff
    • Speakers Bureau
    • Local Chapters
    • Students for a National Health Program
    • Contact Us
    • Privacy Policy
  • Kitchen Table Campaign
    • Maternal Mortality
    • Mental Health Care
    • Health Care Voters Guide
    • COVID-19 Endangers Health Workers
    • COVID-19 Exacerbates Racial Inequities
    • Public Health Emergencies
    • Rural Health Care
    • Racial Health Inequities
    • Surprise Billing
  • About Single Payer
    • What is Single Payer?
      • Policy Details
      • FAQs
      • History of Health Reform
      • Información en Español
    • How do we pay for it?
    • Physicians’ Proposal
      • Full Proposal
      • Supplemental Materials
      • Media Coverage
    • House Bill
    • Senate Bill
  • Stop REACH
    • ProtectMedicare.net
    • Sign our Petition
    • Organizational Sign-On Letter
    • About the REACH Model
    • About Direct Contracting
  • Take Action
    • Medical Society Resolutions
    • Recruit Colleagues
    • Schedule a Grand Rounds
    • Letters to the Editor
    • Lobby Visits
    • Organizing in Red Districts
  • Latest News
    • Sign up for e-alerts
    • Members in the news
    • Health Justice Monitor
    • Articles of Interest
    • Latest Research
    • For the Press
  • Member Resources
    • 2022 Annual Meeting Materials
    • Newsletter
    • Slideshows
    • Materials & Handouts
    • Kitchen Table Campaign
    • COVID-19 Response
      • Why we Need Medicare for All
      • PNHP’s 8-point plan
      • New Study: Perils and Possibilities
      • Emergency COVID-19 Legislation
      • Kitchen Table Toolkit
      • Take Action on COVID-19
      • Telling your COVID-19 story
      • PNHP members in the news
    • Events Calendar
    • Webinars
    • Film Room
    • Join or Renew Your Membership
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