A public option is only likely to expand overall health-insurance coverage to the extent that it is subsidized with additional funds.
Americans appear eager for more affordable health-insurance choices, but don’t want major middle-class tax increases or the government to ration their access to medical care. Whereas a November 2019 Quinnipiac poll found Americans opposed to single-payer proposals 36 percent to 52 percent, the same survey found them supporting the establishment of a public option by a margin of 58 percent to 27 percent.
The state of public opinion has caused Medicare for All advocates to repackage their preferred health-care reform as an ostensibly voluntary public option. The nature of a public option varies greatly depending on the extent to which it competes on a level playing field with private insurance. If it does, then it is unlikely to differ greatly from existing private plans in terms of costs or benefits. If a public option is greatly advantaged by subsidies, taxes, and regulations, relative to private options, then it would be likely to drive them out of existence altogether — leaving the country with a single-payer system, and the associated drawbacks.
A public option featured prominently in the 2009 debate over the Affordable Care Act, and was strongly supported by the AFL-CIO and the left wing of the Democratic party. It was included in versions of the legislation that passed the House, as well as the bill proposed by the Senate committee on Health, Education, Labor, and Pensions, before falling to a filibuster threat from Joe Lieberman.
Chris Pope is a senior fellow at the Manhattan Institute and author of a recent report, “Medicare For All? Lessons from Abroad for Comprehensive Health-Care Reform.” Follow him on Twitter here.
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