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!
Improved medicare for all is the only real change.
Government paid for Single payer healthcare is the only way to guarantee that everyone-even the unemployed-are insured, as is proven by Canada’s healthcare system, and all other first world countries. If healthcare is left up to private industry, millions of people will continue to be uninsured.
Mainstream media does not spread accurate information about ” medicare for all”.
Also, private insurance corporations are not needed, and never were.
They are stupid redundancy.
I’m active with Health Care for All-Oregon, which is continuing to organize for a state level single payer system (despite difficulties with that approach) as well as supporting any movement for national level single payer as it emerges.
Our senator Jeff Merkley seems to be the main mover of this resolution. We regard him as a partial ally, and likely a fuller one when we can make our movement strong enough. Back in 2009 when Bernie Sanders offered an amendment to the bill that would eventually become the ACA, in the HELP Committee of the Senate, to provide explicitly for state-level single payer plans under the bill, Merkley voted for Sanders’ amendment along with Sherrod Brown from Ohio and a fourth senator whose name is escaping me (maybe Whitehouse?). He has promised to vote for any single payer bill that gets to the floor.
In this context, HCAO’s vice president took part in Merkley’s press conference about the “public option” resolution. He used the opportunity to thank Merkley for his support of expanding public social insurance in health care (Medicaid expansion under the ACA) and to point to the ultimate need for a fully public social insurance in health care system.
He also acknowledged Merkley’s main motive, which I do not see in this HC-Now! commentary nor in the comments, which is that the private insurers are abandoning the individual market exchanges including the big federal exchange in droves.
We are seeking to build stronger ties with Merkley and his staff. One of our hopes is to try to get him to sponsor a counterpart to the bill that Jim McDermott from Seattle had in the last session, that would create a much clearer pathway for state level systems by clarifying the position with respect to ERISA and ways to deal with the problems around Medicare and simplify Medicaid waivers. McDermott did not run for re-election due to retirement. I think the national movement should work on finding someone else to sponsor such legislation in the House and work with the growing body of progressive senators to that end too.
I also think we need let go of residual bitterness about the way that some HCAN people in 2009 (I’m looking at you, Andy Stern) used “public option” as a starkly alternative cudgel to beat up the single payer idea. While I think the idea of a public plan option in exchanges as a pathway to single payer that was put forward by Jacob Hacker was always fanciful, people who have supported the idea are not inherently enemies of SP, and we should not treat them as if they are.
My personal opinion is that our movement NEEDS public option advocates to build the movement we ultimately need. So we need to approach them with friendly persuasion about why the architecture of the ACA is unstable and cannot meet the needs we all perceive. Private insurers leaving the exchanges is only one reason. Recent statistics showing that over 40% of EMPLOYMENT based private plans are “high deductible” illustrates the inherent tendency of private health insurance.
So we need to develop a strong case that the health care system remains in crisis.
But we need to do it in a way that is not about promoting an image of superior insight, and that acknowledges the good motives of “incrementalists,” and the very real problems of what we do in the meantime since we are not close to actually achieving SP, on which a great many public option supporters are focused.
And we need to be strategic about engaging the growing number of “both-and” advocates. I count Merkley in that camp in a relatively weak way, and Sanders in a relatively strong way, for our aims. But there are many others. Don Berwick’s coming over to the SP side in his governor’s campaign in Mass. was out of a background that I’m pretty sure included public option in the past and may still to meet immediate needs. SEIU has moved from “use public option to oppose SP” under Andy Stern to “support both public option and SP as they are relevant” under Mary Kay Henry at their recent international convention. We need to continue to encourage those tendencies.
A luta continua!
Onward!
Single Payer for all!
Where is the recommend/thumbs up button ?
Single Payer in the USA – ASAP !
Single payer for all!
I’m for Single Payer first, last and always. Anything else will just postpone our ability to get Single Payer and it looks like a distraction from our main goal. Colorado has single payer on their November ballot and I suggest that every state work to get that resolution/referendum on the ballot whenever that next ballot comes on your state’s calendar. Let’s see what happens in Colorado…………
Oh, also, while “public option” would be at best a temporary fix for private insurers leaving the exchanges and at worst a partial distraction, which we should use to boost the public social insurance idea and identify the continuing crisis of the health system and the ACA’s inability to resolve it, I am actually much more worried about a different “incremental” idea.
To wit, buying into Medicare — which is now a Clinton platform plank.
I am quite concerned about that approach accelerating the conversion of Medicare plans into commodities, already bad enough with Medicare Advantage, and undermining the social insurance principle. Probably the simplest way to allow people to “buy into Medicare” is to expand Medicare Advantage, which would probably tend to undermine traditional Medicare. MA undermines traditional by overcompensating providers, relatively, and also brings all of the narrow network and related problems into Medicare.
Certainly the “expansion” of Medicaid through private managed care organizations argues for what you are saying.
I want Medicare-for-All because I want the insurance companies completely out of the healthcare game. A public option will not keep the insurance companies from continuing to raise the prices to whatever they want. Their greed is pervasive and at this point almost uncontrollable. I will start paying a Medicare premium in November of $121.89 and yet will be unable to use it because I can’t afford the deductable. I want a single payer system that covers everyone and to be free of high premiums, high deductable and co-pays.
what is Sen. Sanders rationale for endorsing a public option? He could have just as well used the same procedural tactic to call for medicare for all couldn’t he.
Bernie is optimistic, altruistics and above all pragmatic, if you are reasonable and logical you do not have to ask why Bernie does something, you’ll know in your gut.
American voters being as they are will have to wait many years for the Universal/National health care to come! This is a large country and the grass root effort is fragmented and unless a politician of the Roosevelt/Eisenhower/Johnson caliber will be in power nothing is bound to happen! (And sorry neither Donald nor Hillary are it!)
I would like to see universal healthcare for all citizens. Whether it is through Medicare, the ACA, or some other government sponsored program, private health insurers should not be allowed to play a part.
The public option does not necessarily take care of the issue of affordability. How much would people pay into Medicare? How much would the deductibles and premiums be? It sounds good, but in reality, I feel it is just a political cosmetic effort. I am on Medicare and cannot afford my premiums, copays, or deductibles. I am lucky that I have found a few doctors who take very small monthly payments.
The consensus of most commenters here seems to be MEDICARE FOR ALL. The incremental approach of the Public Option will just be a delaying tactic and a further gift to the insurance companies. The Medicare structure is already in place, has been working well for years, and expanding it to Universal Coverage will be the least trouble and expense.
It does need to be improved. Medicare deductibles are still too high for many seniors once they age into the system. That’s why we say “Improved Medicare for All.”
The medical industry, Big Pharma, Big Insurance and Big Medicine, screams out for some type of regulation after years of abuse after profit rather then patient service became the primary incentive. I support legislation will provide for a single payer such as Medicare for all.
Medicare for all — everyone in, nobody out! Single payer is the best way to achieve universal coverage; the public option is a diversion tactic that works against this goal. Fool me once…
The “public option” (PO) isn’t just inadequate or watered-down. It’s a horrible idea, designed to get progressives chasing down a dead end for an idea that, if adopted, would discredit public coverage for decades to come.
If the PO is set up to be better than commercial insurance – e.g., a more open network, better out-of-network coverage, and lower deductibles, yet with competitive or lower premiums – it will naturally attract enrollees with a higher need for services, and go broke. Public health coverage will be discredited. If the PO is set up to operates just like commercial insurance, people will be angry about denied benefits, narrow networks, and high deductibles. Public health coverage will be discredited.
It’s complicated enough trying to explain single payer to people who are fed insurance company propaganda. Imagine trying to explain that we really should have single payer, but instead we’re asking you to support PO.
It’s hard enough convincing many people that a government program can really be good. At least with single payer, we can point to distinct features that make it better. There is none of that with PO.
Unless the insurance industry decides PO is a great way to discredit public coverage, it will fight against PO as strongly as it will fight against anything single payer. Progressives will fritter their energy away fighting for “half a loaf” that actually is rotten bread.
Single payer is the right plan – the only sensible plan – on the merits and on the politics.
Richard N. Gottfried, NY State Assembly Health Committee chair; sponsor of the NY Health Act single payer bill
Having lived under both the US for profit at all costs and the Canadian Universal healthcare, there is no question in my mind that we should move as quickly as possible to universal single payer. Get the obscene profits and obscene salaries out of health insurance.
The United States is the wealthiest nation and one of the few without Universal/National health care. This is not acceptable. The present system of for profit insurance companies increases not only the cost of insurance but limits the access to medical care.
I believe a single payer health plan like medicare should continue as our main objective. However, we should not impede the progress of the public option. It could be a step toward our plan for Medicare for all… in a round about way. It will wake up the public more to a government run health care program. Anita Owen
My question is, will the insurance companies still be involved. I find it offensive, and counterproductive to the cause when you have shareholders driving the bus, and a bigger than life roadblock to the direction healthcare in America should be.
The public option is the correct, ethical way to go.
The way we do it now allows greedy corporations with no ethics to take advantage of people by sacrificing their health and lives for the sake of profit taking.
WE NEED SIGLE PAYOR FOR ALL! This however would be a welcome step. congress basically has a “public option” and so should the American people. it wont fix the all problems with healthcare but it would help A LOT!
No doubt about it: we must have universal health care in the US. Why not? Most advanced countries have it. But with that advancement we must also nationalize all healthcare. I think that large medical corporations are fleecing the public. Allowing them to continue to set the pricing for medical care would undermine any universal healthcare system.
The Public Option is essential. My son has ACA, otherwise, he wouldn’t have health insurance and therefore a job because of a health condition. So this year the insurance company has changed things. He must pay a prohibitive co-pay for care. He does qualify for the best ACA deal. But under that plan, there are no physicians within a two hour drive. These insurance companies make the whole thing into a racket.
I pay $96 per month for a so-called “employer-provided” health plan, on a $10-per-hour gross salary, which provides for nothing other than a few “required” preventive tests, the treatments for which I’d never be able to access if any turned out positive. It has a $5,000 deductible, nearly 35% of my annual take-home pay. I am a Type 2 diabetic, 3 years shy of Medicare, who hasn’t taken medicine since last winter when I was dropped from Medicaid after getting this job.
Do the 4th-grade math.
I’m only including these personal specifics to stress how vitally important it is to realize that health care is a vital human need, one of those things — along with K-12 education, public infrastructure, libraries, police, firefighters and everything else a modern society needs — that must remain outside of the private marketplace. We pay for those things together and receive them together.
It’s time to join the rest of the industrialized world and include health care as part of the public trust. I don’t know if I personally will make it in time, but please, please fight for this as a universal right. I wouldn’t wish a worry like this on anyone else. It is indeed your responsibility as a citizen of a great nation to affect change when it’s needed.
I’m a firm supporter of some form of single-payer universal health care. If the public option had been introduced as part of the ACA I would have supported it, but at this stage I believe that we must move to a true single payer system if we are to truly contain health care costs. A single payer system will reduce administrative costs for both providers and patients. And a single payer system will be able to more efficiently begin to deal with the other cost drivers in our current system, namely pharmaceuticals, an over dependence on specialists and technology, and lack of investment in primary care providers and public health issues.
Medicare recipients (and I am one) will tell you how well this health insurance works. Why should only older people benefit from this system? It should be extended as a single-payer system to include younger people and children — everyone. Single payer is both ethical and humane. Our existing health care industry which functions as a source of huge profit for pharmaceutical and health insurance companies does so at the expense of vulnerable people.
we need to take private-profit-first out of health care , as well as everything else ,and replace it with public-profit-first, then begin to work on making life better for the greatest majority by taxing the hell out of the tiny minority who’ve gained incredibly stupid wealth – individual billionaires? are we crazy or stupid? -, then consider why the hell profit should exist at all..that means begin democracy and save humanity by ending capitalism.
Universal healthcare for all. No insurance middlemen making millions. Curbing healthcare costs by negotiating fixed rates with hospitals, pharmaceutical companies and transparency so you know in advance what you are being charged for and why.
I see no reason (except political) why the U.S. cannot have a signed payer health system. But there is much to be done to persuade so many Americans who disagree (especially polititions).
Improved Medicare for all is the way to go, but only if it continues to have the bargaining power with the health care industry. Health care charges have gone way beyond obscene, with too many hospital providers with shareholders to pay etc. In 2004 my husband had 4 stents placed, spent 24 hours in the hospital, and the hospital bill was a bit over $72,000!! Medicare paid the hospital $15,000! Dental costs are outrageous also – I’m having 1 molar replaced at a cost of a bit over $3,000 – thankfully I have dental insurance. How can the average person afford any of this? Good hearing aids are around $5,000. So it isn’t just insurance companies, but the costs of the whole system that are out of control.
I continue to post my support for Single Payer…on the Healthcare of Oregon site, Jeff Merkley’s site (he’s my Senator) and anywhere else that’s applicable. The so-called Public Option is just another insurance company and a another sop to those greedy blood-sucking health insurers. Until we eliminate the middleman and stop taking these mincing baby steps, we will continue to be at their mercy. I am a senior and use Medicare, yet feel strongly that everyone should have that option (without the sham that’s Part D). Single Payer for every citizen is the only acceptable and feasible answer to insure that healthcare outcomes don’t break the bank.
I’m really needing this as I’ve been without healthcare coverage since the ACA went into effect (I work for awful companies who don’t want to provide any benefits to their employees). I pay the annual penalty as it is cheaper than actually having coverage. It shouldn’t be like that. I’ve paid into the insurance companies all my life and now when I need it the most they’re nowhere to be found. I can’t afford the insurance, can’t afford the penalty, can’t afford to get sick or have any health problems of any kind. I pray that I can just hang on until I’m eligible for Medicare (another 11 years).
The most viable solution is Medicare for All
Single payer is what civilized countries have. We don’t think we can have it because the rich have convinced us that there is not enough money for such extravagance. The problem is that the rich have been not paying their share for decades and have run the checkbook dry, while blaming it on the poor. Make them pay their bill!
Anything short of a single-payer system will be letting the American people down. They will continue to avoid going for medical help due to large co-pays and high deductibles, if they have health insurance at all. People will continue to die without the care they need and will continue to lose their financial security, even while they are struggling to regain their health. The annual deductibles will continue to drain peoples bank accounts, even as they are receiving treatment for a medical condition that crosses into the new policy year. It is wise to remember that simply having some form of ‘health INSURANCE’ does NOT equate to being able to access good,affordable HEALTH CARE with the providers of our choice! We need easy access to comprehensive health care, not complex, possible access to health care through expensive private, for-profit health insurance.
Get the insurance company’s out of the pharmaceutical side of medicare..
There involvement is ridiculous, financial malfeasance,directing huge amounts of money to a not needed,incompetent,fraudulent, bull shit artists.
Who dreamed up this 800 pound gorilla in the room crap?
I agree with Richard Godfried that the public option would be a disaster.
if the public option provided real healthcare, it would be swamped with sick patients needing more care and would have to raise its rates, leaving it with fewer even-sicker patients. The process would repeat itself to become a death spiral.
If the public option had constant, competitive rates, it would inevitably reduce its services, networks, formularies, etc, providing abominable care for say 95% of the population, while the richest 5% would get good care through expensive private plans.
To me, this is the more likely scenario, that the public option is being introduced to greatly speed up the ACA’s agenda of clamping down on the quality of healthcare for the vast majority of us, and greatly reduce the healthcare expense paid by corporations.
What’s most sobering to realize, though, is that these same dynamics and agendas that would occur under the public option would also occur under single-payer. The corporate-financial world is unanimous in wanting to cut costs and drive down services for today’s Medicare; why would it feel different about tomorrow’s Medicare-for-All?
The corporate-financial world may be willing to jettison the overblown health insurance sector with its uncertain profits; but once it’s out of the way won’t the corporate financial world say that healthcare is *still* to expensive and needs to be cut? We do see the drug industry re-tooling to make profits selling small amounts of fabulously overpriced specialty and even personalized cancer and other drugs to the top 5%. And hospital chains are consolidating and closing hospitals, as well as devising new treatment protocols that go beyond quicker and sicker discharges to not letting patients in the hospitals at all. None of this bodes well for our patient care.
What this is all saying is that the problems of healthcare are not going to be solved by the perfectly rational plan, and certainty not going to be solved by devising a win-win solution with the corporate-financial world. The struggle for healthcare is a struggle between us and that corporate-financial world, and it comes up in every strike for safe staffing or medical benefits, every occupation against a hospital closing, every protest of a rate or drug price increase, every demand for healthcare for undocumented immigrants, it’s all around us. If our concerns aren’t on the table, kick the table over.
Medicare for all is what’s needed
We need universal health care in America. It’s a human right.
Health care should not be a for-profit business.
I traveled throughout Europe and Scandinavia as a professional pilot and saw how seamless and effective their “single-payer”/ universal health car functioned. It will take a lot of courage for a lot of politicians to stand up to the health care lobbyists, but the transition is a no-brainer
I support a public option, Medicare for all, or the plan our elected officials receive.
We have run out of options! there is only one… the public option that begins to make universal health care possible. At this point doctors have been robbed of their authority to prescribe by insurance companies. Cost dictates care. Hospitals are sold for real estate profit. Hospital beds are in short supply. Patients are turned out of their beds and doctor recommendations are not valued unless they increase profits of insurance companies. . Medical school costs are out of control while malpractice insurance goes through the roof… all of which gets passed on to the patient.Something has got to change. I think we have run out of even pretending we have another option — lets consider the one we refuse to try.
Get rid of the EXEMPT FROM ANTI TRUST insurers and have a government administered program designed to care for people without the greedy for-profit motive designed to take our ills HOSTAGE .
I am fully for single payer insurance but realize it will not be an easy task to make it happen for the best benefit of all. I have great positive regard for Colorado putting it on the ballot this year.
I have Medicare and it is wonderful. More people need this kind of system.
My wife and I have both been on Medicare for decades, until her recent demise from many years of progressively ill health. We never had a problem with Medicare and without it would have lost our home and not received the care that enabled her to live so long. There are some individuals, some doctors, and some hospital corporations that cheat, but most do not. I know from personal experience that it is a well-administered and efficiently-run program, despite the cynics who say government can’t do anything right. Medicare For All would further cut the cost of national health care. We need it badly.
Healthcare should not be for profit. Until we have single payer healthcare for all nothing will change. The only way to give healthcare for all a chance is to vote blue. Voting red will take healthcare away from millions. There is nothing more important that one’s health. Nothing. We should be born with healthcare that covers us till we die.
Why have for profit insurance companies in the middle, siphoning off money from the consumer or the government taxpayer? Public Option may be a middle ground compromise, but we need to get universal, single payer Medicare for all enacted with all deliberate speed. For profit health insurance or “Hand the Money Over” HMO’s are part of the problem. They need to be put out of business and the government through Medicare and CMMS under HHS or Health and Human Services should be the public health insurer. One Formularly for drugs, one set of codes for diseases, illness, injuries and treatments paying medical providers. Healthcare is a right not a privilege. Making profit off of treating or not treating a patient is sick, immoral, stupid and crazy. How much money is wasted by people whose spouse has a different medical plan, when one insurance provider approves of a a procedure and another does not, even though it is medically necessary, all because of the COB or Coordinator of Benefits Birthday Rule. This is what has happened to me, even though both my wife and I had Blue Cross and Blue Shield Coverage, under separate employers, received permission and referral from our Primary Care Physician for a colonoscopy. I received a notice that my colonoscopy wouldn’t be covered because it was not approved. Colon Cancer runs in both sides of my family. Do you think I would schedule a colonoscopy on a whim or as an “elective procedure?” No wonder our healthcare system is so expensive and has poor outcomes. Even if you follow the rules, some bureaucrat, trying to save money for the for profit insurance company sends out a notice saying that the procedure won’t be covered. Insane, wasteful and stupid. How much profit is enough for these insurance companies? They are addicted to profits, not helping people get well or stay well.
Healthcare is a human right, and our government needs to recognize this and act accordingly. Period!
The ACA has not brought relief from high health care costs. The insurance companies are still in charge and they will continue to raise premiums and narrow options for patients. Health insurance is not worth what we pay and is the wrong solution for financing health care.
My daughter (a millennial) says she and many of her friends feel they are better off paying the fine for not having health insurance than buying insurance that does not protect them from high costs. See my Health Care rant at http://www.theseekerbooks.com/articles/WhatsWrong.html
“Life, liberty , and the pursuit of happiness…” cannot be achieved without quality universal health care for all. And, if problems develop with the system, we can hold our elected officials accountable until they fix it.
Imagine…a real issue to consider when going to the polls.
How many people have died or become irretrievable ill because of denial of health care or its unaffordability in the US?
How many people have been anguished and wasted untold number of hours trying to navigate the system of which doctors are approved under their health care insurance plan or trying to find out the costs of a procedure in the US?
How many people have been hugely overcharged for prescriptions in the US?