The Public Option and Momentum for Single Payer

September 22, 2016

Calls for a “public option” in healthcare – a publicly run health insurance plan that would compete with private insurers – have made a comeback in recent days. But it’s not a comeback like Robert Downey Jr. after rehab or the Cleveland Cavaliers after game 4 of the finals. More like Corey Feldman as a dancer-singer, or Speed 2 the sequel.

A group of Democratic Senators including Bernie Sanders introduced a Senate Resolution for a public option on September 15. It’s not legislation and contains no details, but rather a symbolic statement of support for the concept. The resolution is backed by a group of online organizations and petitions, but is not part of any grassroots campaign. The proposal comes, somewhat suspiciously, after Bernie Sanders nearly staged a coup within the Democratic Party running on a platform of single-payer reform, but subsequently agreed to support Clinton and her call for a public option during the general elections.

While there’s no bad time to champion a good idea, the public option is limited as a solution to the problems that ail the Affordable Care Act, and even more problematic as a vehicle for building a social movement over the next 2 years when, in all likelihood, neither Democrats nor Republicans will be able to advance major legislation through Congress. A strong public option would generate a similar level of political opposition as pushing improved Medicare for All, but without the benefit of solving the healthcare crisis. In the current political context, it offers neither vision nor political pragmatism.

The public option is an appealing policy for Democrats during an election year, since it’s a public plan that fits with free market ideology and polls well. It promises to drive down private insurance costs through competition, and there are very few of us who wouldn’t give anything for relief from healthcare costs and the promise of a more humane insurance plan.

Unfortunately, competition does not work for health insurance, since the “cost” of insurance plans – what we’ll pay in premiums, co-payments, deductibles, and uncovered care – is almost impossible for even intelligent people to determine. Study after study has shown that very few people select the plan that’s cheapest for them. One experiment found that only Columbia MBA students chose insurance plans better than randomly picking a plan out of a hat.

Insurers win customers in the marketplace not by selling the “cheapest” plans, but by pushing plans that are appealing when you buy them but a nightmare when you have to use them: this means lower upfront costs (premiums) with much higher uncertain costs at the point of care (deductibles, co-pays, out-of-network care, uncovered benefits, etc).

So in order for the public option plans to “compete,” they will be under pressure to establish narrow networks, limit benefits, and utilize other practices that allow them to sell more insurance while shifting costs onto patients.

This is exactly how a very similar policy included in the ACA played out. Obamacare allowed the creation of non-profit cooperative insurance plans designed to compete with commercial insurers. The coops have failed spectacularly over the past two years, with 17 of the 23 coops created in 2014 closing their doors by 2016. The plans did not have the size or bargaining power to negotiate low prices with large hospital chains and physician networks, and offered premiums on the exchanges too low to cover their expenses.

The upsurge of national support for improved Medicare for All generated by the Sanders campaign has created a tremendous opportunity to advance the movement for healthcare justice in the United States, regardless of the posturing that will continue to take place during the general elections. Now is the time to build on that momentum through organizing and outreach: take action today!


  1. James henderer on September 23, 2016 at 11:18 am

    Single payer health care is the best solution for social justice.

    • jharmer on October 5, 2016 at 2:14 pm


    • Deborah Schumann, M.D. on November 25, 2016 at 8:00 pm

      A lot of Republicans, libertarians and conservatives don’t want anything with “public” in its name. My idea is to craft legislation in Congress that offers two choices to the states: Each state can choose either:
      1. Improved Medicare for All (a public option) or
      2. Market-Based Coverage.

      Each state must choose one or the other in order to continue to receive federal dollars. #1 is a single-payer option that incorporates federal, state and individual dollars into a system that includes everyone. #2 is a market based system that promotes insurance competition across state lines, gives block grants for Medicaid and maintains the for-profit insurance and drug industries.


  2. J Kosiorek on September 23, 2016 at 11:54 am

    There is not a single valid argument against single payer. Public option is a desperate attempt to secure corporate profits in healthcare. Ignorance is the only way that our current healthcare system is tolerated

  3. sheila on September 23, 2016 at 12:04 pm


  4. jfurstoss on September 23, 2016 at 12:07 pm

    As a Health Care Provider for over 27 years, I know this is one of the greatest urgencies in which the U.S. MUST catch up to the rest of the world. This is Social Justice and our future.

  5. Susan DuBois on September 23, 2016 at 12:15 pm

    If we’re going to campaign for something, we should campaign for single payer. A public option will fail pretty quickly because the insurance companies will off-load their highest needs customers onto the public insurance. I agree that we should not demonize people who are supporting this recent call for a public option, but we should point out its inadequacies and enlist those supporters to go after a single payer system instead.

    • rebecca sawyer-spoon on September 23, 2016 at 3:15 pm

      We should call single payer “healthcare justice and equality for all” and demand that it be guaranteed under the law of our land as a basic human and civil right…like every other civilized nation on Earth but ours did years ago.

  6. Philip Johnston on September 23, 2016 at 12:20 pm

    Single Payer is the best solution for providing the best quality of care to everyone at the most affordable cost. Medicare For All, NOW!!!

  7. Emma Lou Sailors on September 23, 2016 at 12:48 pm

    I cling to the idea that a “public option” would be a start. Although we are agreed that Medicare for All is the goal, an incremental plan may be the best approach and the only possible one in the US, a country so entrenched in capitalism and the profit motive.

    In an era when major (and inefficient) carriers are abandoning the ACA, I believe the effectiveness and efficiency of a Medicare-like plan would demonstrate its value, as it did in Canada.

    • rebecca sawyer-spoon on September 23, 2016 at 3:17 pm

      The biggest problem with that theory is how many more millions of innocent lives and trillions of healthcare dollars will have to be wasted in the meantime while our leaders fiddle.

  8. Gunnel Clark on September 23, 2016 at 1:23 pm

    Single payer is the only way. Get insurance companies out of healthcare.

  9. John and AJ Jittipsopa-Zinner on September 23, 2016 at 1:36 pm

    Single payer health care is long overdue in the USA and it is only a step in the right direction. The absence of single payer health care just points out how backwards we really are as compared to so many other countries and not just in the arena of health care. Let’s get this one done as a step in the right direction.

  10. Piotr Sliwka on September 23, 2016 at 1:45 pm

    There are over 400,000 low income Virginia residents with zero health insurance coverage, because Virginia Senate and House of Delegates denies Medicaid expansion year after year. Virginia senator Richard Black and delegate Bob Marshal are leaders and champions in denying Virginia Medicaid expansion. A low income Virginia resident is a person with an annual adjusted federal income of $16,000 and even less before reaching age of 62 years. A heart by-pass costs around $60,000; a MRI costs around $700; a CAT scan costs around $700, and a huge plethora of other hospital and physician surgeries, tests, physical therapies, nuclear medicine, cancer treatments, and so forth are completely out of patient and check book range for almost half a million Virginia residents, because president Barack Obama and the U.S. Congress could not, or lacked courage years ago to go ahead with Single Payer Based on Medicare for All American a few years ago, Instead, we were given this quilt of many greedy for profit private insurance companies, which always increase premiums, drop out of exchanges, and still have huge yearly deductibles from $5,000 to even $10,000, so what is the purpose of having private health insurance for a middle class working American, when such an insurance asks year after year for such a patient to shell out $5,000 or even $10,000 before a private insurance pays for anything with still strings attached how many percent (%) an insurance will pay or not. North Carolina has about one million state residents with zero health insurance, because just like in Virginia Medicaid expansion has been denied. This policy of not insuring so many American citizens is criminal. There are many more states, which opted 100% out of covering low income American citizens, and Virginia and North Carolina are just two examples. When one looks on the map of continental U.S. those states denying Medicaid expansion are former slave states. Public Option or Medicare for all Americans; the time has come to end financial slavery of low income American citizens. Either expand the Public Option, or cover all Americans with Medicare regardless of age and disability. Medicare is far more efficient and less expensive from many private health plans. In addition, Veterans Affairs health system is even more efficient from Medicare, according to AFGE president MR. Cox; however, many politicians have this idea that privatization of VA is the cure for all its problems, which would be a bonanza of profits for private health insurance. Veterans Affairs health system has been drastically defunded by U.S. Congress to create this false pretense for privatization. Many Social Security field offices have been closed down to slow down to a trickle processing of disability claims in order to create this false perception about inefficient federal programs. When Medicare will be able to negotiate drug prices, there will far less problems with Medicare.

  11. Denise Tschann on September 23, 2016 at 2:07 pm

    Single payer for the health of our citizens.

  12. Laurel Whittaker on September 23, 2016 at 2:11 pm

    Pool in – pay out. The only way that healthcare can be delivered to Americans. Prices for healthcare and prescriptions are so high in this country that when people pay for insurance premiums and also receive bills due to deductibles and co-pays, we’re still going bankrupt or going without healthcare. Eliminate the middle man. The only way.

  13. Bob Mason on September 23, 2016 at 2:52 pm

    I totally support this position of continuing the campaign for single payer for all the reasons stated.

    • richard patten on September 23, 2016 at 3:16 pm

      There is a place for leveraging (profit mongering), but it is not in providing health care, legislating or journalistic reporting. Most recent evidence in jacking up prices for aids medicine and epi pens. Yet the public (medicare) is not allowed to do this (leverage its buying power) for medicine in general. Conclusion: Drug companies rule Congress, with members of Congress allowed to leverage their votes for profit. A corrupt system! Major media involved also in not making an issue of this and help making our system of government work–which was the constitutional justification for free press in the first place. A co-opted press is not a free press.

  14. dianne on September 23, 2016 at 3:00 pm

    On a recent flight to Geneva, Switzerland, my 23 yo Lebanese seat mate on his way to visit his family for a week said he would like to work in America just to see what it’s like, but he wouldn’t want to live there. I asked him why, and he replied that America is not a country, it’s a huge business – a corporation.

    This is why, sadly, we will never see single payer in America. As for the voice of the people, there is not enough noise coming from them against the status quo or against Obamacare which is fraud disguised as health care reform. And, the majority of Americans believe what they are told by politicians: single payer is socialist – communist.

    I have used the French health care system for the past two years. We should be so lucky. Several examples: 8 days in a French hospital cost me about $8,300.00 – this included everything – 5 X-rays, 3 CTs, several specialists, ongoing intravenous medication, food (gourmet with a superb menu to choose from), nurses, other RX. You wouldn’t get half a day in America for that price.

    Anticoagulent – brand by Bristol, Myers, Squibb – 20 2 mg pills = just under $3 – same in America where I live = $90. The copayment for the generic in America is more than the brand in France.

    Just under $30 to see the general doctor (primary in America), $80 for a specialist consultation which included a dopplar, $15 for a blood test, and so on.

    These prices are what a person pays in France who is not covered by the French health care system. A French resident would have been reimbursed for part of those costs.

    If you need your lab results, you can phone the lab (or the lab can phone you), give a code which is on your reminder slip to call the lab and you have your results. And, if you have any questions you can speak with the biologist. The system is totally used-friendly and efficient. The doctors are as anywhere. Either you like the doctor or not.

    The French system is called la Sécurité Sociale – the French call it “la Sécu.” In American we have Social Security which is the gov’t pension we receive at a certain age for which we have paid for through taxes. Try to take away Social Security from an American and you will hear loud noises. Politicians won’t go there. It’s the third rail.

    My point in bringing this up is that Americans don’t mind receiving SS benefits and do not call this socialist when ironically the French health care system has the same name, and the vast majority of Americans say it is socialist, we don’t want it. Meanwhile, they have NO clue how it works in France which has a single payer system, and they are not interested in being educated. They complain about America’s disease-maintenance system but continue to bend over for the status quo.

  15. dianne on September 23, 2016 at 3:04 pm

    Forgot to mention in my post above, my seat mate on the flight to Geneva lives and works in Montreal, not America, a place where he would not want to live and why as I did mention.

  16. sandra l lawrence on September 23, 2016 at 3:19 pm

    I am sending this message in response to various petition requests from organizations wanting signed support for the Public Option scam. Last one I sent was to the AFL-CIO:

    The Public Option is *not* the same as Single Payer. The AFL-CIO should be pushing for H.R. 676 – “Expanded and Improved Medicare for All”, if you are for “People Power,” as you claim. Why settle for crumbs in the form of the right to pay through the nose for insurance, rather than the right to healthcare – AGAIN! ?

    When you send me *that* petition, I will gladly sign it!

  17. Dr. Kenneth A. Harris on September 23, 2016 at 4:23 pm

    Have you ever wondered why legal representation is guaranteed in our society, but crucial health care is not? Odd, don’t you think? Big Insurance saddles the population with high premiums, arbitrary diagnoses, and enormous salaries and benefits for its overlords. Actual contributions to health? It’s doctors and nurses that do this, not insurance executives. We need to get in line with the rest of the industrialized world and have single-payer health care for all citizens.

  18. Betty Craft on September 23, 2016 at 4:55 pm

    Medicare for all is a must!!!

  19. Joseph Eusterman MD on September 23, 2016 at 5:18 pm


  20. Rod Ryon on September 23, 2016 at 5:18 pm

    If public option were to pass, and I were President, I would sign it; if I were a Senator I’d vote for it. But I’m instead a member of Healthcare-Now and work for p.o. would be a diversion. Use the discussion about healthcare to speak up for single-payer.

  21. Miriam C. Kaplan on September 23, 2016 at 6:30 pm

    What we need as human beings is single payer healthcare for all, no matter what.

  22. Antonio Bernal on September 23, 2016 at 7:22 pm

    The White House is sick, Wall St is sick and the Pentagon is sick. Medical care NOW

  23. Laurie Robertson-Lorant on September 23, 2016 at 7:52 pm

    Single payer for ALL!!!

  24. Carol Boucher on September 23, 2016 at 8:33 pm

    the public option is just more anti-single payer snake oil

  25. Pam Krimsky on September 23, 2016 at 8:51 pm

    Profit has absolutely no place in health care.

  26. Christopher Ellis on September 24, 2016 at 7:11 am

    It is nothing less than obscene to make a business out of peoples illness in a so called civilized country.
    To have to choose between life and death because of cost?
    Profit based Insurance Co’s are in it for just that ‘profit’
    Is that why health care costs can cost a family in America as much as their monthly mortgage?
    Is for profit healthcare is an hypocrisy to the hippocratic oath ?

  27. Roxanne Decktor on September 24, 2016 at 7:38 am

    Single Payer Healthcare will make our country healthy. Our brains are wired for cooperation; having public cooperation for our health is logical. We need to continue to awaken each to this necessary “Common Good.”

  28. Katherine on September 24, 2016 at 10:30 am

    A public option would absolutely offer lower overall costs for beneficiaries, which would be attractive to young, healthy people, which would help to mitigate the effects of adverse selection. The lower prices would instantly drain private plans of hordes of their customers, which in turn would increase public plan negotiation power and drive down private plan prices.

    In order to coax provider$ to actually accept the public option patients, federal subsidies would have to accompany the option in order to (over) compensate them. This would indeed make it unsustainable in the long term, IF the public plans totally suck and no one wants them anyway. If they don’t -if the public option is substantially cheaper and you can get decent care- yet more customers will dump their private plans. As this snowballs, the option requires less federal life support, the privates continue to implode, rural hospitals stop closing left and right in non-expansion states, and the nation as a whole gets a sweet taste of what all-out single-payer would be like, further increasing its likelihood of becoming reality sooner than later.

    The far more intractable problem than adverse selection and political distraction from single-payer is the price of medical inputs– goods and services priced arbitrarily by pharma, physicians, hospitals, and device manufacturers. Collectively the most powerful lobby in Washington and at the state level. The murderous pricing system is legislatively protected by politicians whose top campaign donors are Big Med.

    The public option would be a start, and single-payer would be its consequence, but we will NOT realize the kind of significant savings with such plans in place unless and until the Big Med cash pipeline is stanched. Now, this can happen a) by voters simply refusing to vote for career polys funded by Big Med, b) campaign finance reform, and/or c) fighting fire with fire and basically mobilizing private money to pay reformers’ ways into Congress and state legislatures and to pay the current glut of profiteering lawmakers’ ways out.

    Advocate organizations need to dispense with the focus on rallying public support for single-payer and investing in pressuring individual legislators to get on board. They should spend their money promoting the end of the medical industry stranglehold on politics. Profiteering polys will flee the pursuit of statecraft if it stops being so lucrative because the Big Med gravy train has come to a halt. They won’t hold on because they don’t care about making laws. They will go to Wall Street, big law, real estate, capital investment, etc. to make their careers because they are motivated by one thing and it ain’t your health and well-being.

    Don’t mess around rallying a powerless voter base that already agrees about what needs to be done. Put on the big-boy pants and start fundraising with the new crop of benevolent tycoons that are dumping cash into crap like rare disease research and other statistically insignificant health science pursuits. Didn’t Zuck just pledge several billion to ‘end all diseases’ last week? He could’ve taken that stack and literally paid all these state and federal -level profiteers who are keeping us from healthcare access to permanently go away. Yes it’s depressing and it sucks and yadda yadda yadda that it would be that easy for one guy’s money to uninstall and re-install the ultimate decision-makers in this effort. But that reality is already entrenched. To wit: the Kochs.

    So let’s reconsider our strategy of promoting this crucial legislation by ending the duplicative, non-evidence-based PR interventions to garner public support for something that public support has not and will not change without a total house-cleaning of the Big Med lobby and its best friends, particularly -but certainly not exclusively- on the right. Let’s start rubbing elbows, holding back-door meetings with billionaires and develop the kind of cohesive, well-oiled mammoth fund-raising machine that our nation’s best moneymakers love pouring money into. Let’s do this the capitalist way even if we need to hold our noses the whole way. Because idealism won’t. get. people. covered.

    Fired up? Email me.

  29. Phong on September 24, 2016 at 10:49 am

    Single payer is essential to a free society.

  30. Kirk on September 24, 2016 at 12:27 pm

    Universal health care like the uk system completely non profit is the only way to cut costs.

  31. Steve on September 24, 2016 at 2:42 pm

    As a Brit who became an American, I grew up with the National Health Service. Don’t believe the lies — the NHS is amazing. Not having socialized healthcare is the single worst thing about living in America and the single issue that makes my blood boil. It is so transparently clear that healthcare for profit is wrong and serves nobody but the insurance industries who are leeches, getting rich off sickness and death. Free healthcare for all is a human right. It is LONG overdue in the United States. Oh, and FUCK THE DEMOCRATIC PARTY, who would not even allow the public option on their 2016 campaign platform.

  32. Crystal A. Mourad on September 24, 2016 at 3:36 pm

    Single Payer healthcare has its drawbacks BUT ACA and health insurance does not work! Medicare has become so fragmented and piecemeal. Get the insurance companies OUT of the healthcare industry. Create set fees for doctors and therapies. Create a system and do it right the first time then leave it alone! We including the government are not getting what we pay for and both patients and doctors are suffering for it. I have been working with healthcare for forty years and its a disgrace! Take the “profit” out of the industry. Set fair prices even for drugs. Reward outcomes. Seek cures vs maintenance drugs. Try Canada’s system!

  33. letthetruthbeheard on September 24, 2016 at 4:24 pm

    Supposedly the US is one of the most advanced nations on the planet, yet we still don’t have health care as a human right. It’s time to wake up and become active citizens, get out and vote for the ONLY noncorporate candidate, Dr. Jill Stein. If you’re not familiar with her intelligent, issue based campaign for human rights, social justice, repairing and protecting our human caused destruction of the planet, and so much more, search online to see her amazing speeches and interviews. The best interviews to watch are from nonbiased sources such as The Humanist Report, The New Progressive Voice, and Democracy Now! are a few honest sources.
    The facts and the math is out there, Dr. Jill Stein has the numbers to easily win this election. She will turn the White House into a Green House and stand with the 99% of Americans for People, Planet, & Peace, over corporate profit.

  34. Mitchells on September 24, 2016 at 4:34 pm

    Single health care is the best solution, taking the profit out of folks’ health and off the backs of everyone including businesses.

  35. Teresa Fry on September 24, 2016 at 7:22 pm

    The Public Option is another half measure that doesn’t solve the problem. Single payer is a far superior solution and logical replacement of the disgraceful system we now have.

  36. Jim Criner on September 24, 2016 at 8:26 pm

    I will be dead by the time we get single payer system. It I immoral that our politicians could care less about our health but are in love with money. They tout how great God is but refuse to help people. I’m sure my Lord Jesus didn’t charge for his compassion but would expect us to help others. So very sad!!

  37. T Peckham on September 25, 2016 at 4:04 am

    “Public Option” is a political ploy. We need single payer/Medicare For All/universal health care. All advocacy groups and all of us need to decide on ONE NAME for it and push it hard to the undereducated masses. Semantics matter. I think “single payer” is the least effective: it’s too easy for the big-govt. haters to attack. It”s difficult to know which is harder to beat: the health insurance industry or the willfully ignorant, “I got mine; you get your own” American public.

  38. Dan Muldoon on September 26, 2016 at 11:07 am

    As things are now, bankruptcy court is the de facto healthcare coverage for too many people.

    Public or private, single-provider or many providers, reform has to mean that nobody ever has to worry that getting sick or injured will mean financial ruin. And nevermore should any correspondence from a hospital/clinic/etc. include the term “collection agency.”

  39. Ken Myers on September 26, 2016 at 6:13 pm

    You point out that this is a resolution and has no details, but you attack it vehemently. Knowing the details might be important. I am not sure how you define “grassroots campaign”. You are critical of “online organizations” at a time when there is significant social activism occurring via that mechanism. You claim that to be competitive the public option will be under pressure to narrow networks, limit benefits while shifting costs to patients. Using a government plan like Medicare the public option should save around 15% in administrative costs, so the price should be very attractive and require few, if any, co-pays and deductibles. It would probably also drive down for-profit insurance premiums. You claim the coops failed because they were too small and had no bargaining power. The public option would be very large, having enormous bargaining power.

  40. Liz Trojan on September 26, 2016 at 7:03 pm

    You can always count on Americans to do the right thing – after they’ve tried everything else. Winston Churchill

    This quote was about the war effort but it seems to apply to healthcare as well.

  41. Bruce Thomson MD on September 26, 2016 at 7:51 pm

    Public option is more of the same corporate control over health care dollars. That’s their game, dollars not so much healthcare.
    Single payer has many forms and perhaps improved Medicare for all is a reasonable comparison. The state of Maryland has been regulating payments to hospitals for nearly 25 hrs, dealing with private health insurers. An interesting cost saving experiment. But we can and need to do better with a thoughtful all inclusive single payer format. Thoughts from a retired Family Physician

  42. Mabel McElhaney on September 27, 2016 at 6:17 pm

    I will accept nothing less than John Conyers’ HR 676, Improved and Expanded Medicare for All Act. It is our economy’s wet dream.

  43. Tim Bardell on September 27, 2016 at 7:12 pm

    Health care affects us all – we are all TABs (temporarily able bodied). So we should all pay into a single-payer heath plan that keeps us all healthier. Then we can control costs by prosecuting fraud, negotiating treatment prices, and training more primary physicians and nurses.

  44. Aileen Wedvik on September 30, 2016 at 10:24 am

    MEDICARE FOR ALL!!!! It’ll save lives. It is CRIMINAL to keep our current system. Simply criminal……and cruel and I humane.

  45. bill shaver on November 14, 2016 at 12:30 pm

    wonder if the paper hanger strumpette will institute this as any REAl man of buisness knows this is the way to go on health care.single payer…