Note: Naturally, I try to do my due diligence and back up every claim I make with reliable sources. If you think I have misrepresented the facts in any way, I’m always open to calm, measured responses backed by evidence. I have changed my mind many times about many things, and will likely continue to do so.
Senator Bernie Sanders and many of his supporters seem keen on suggesting that his plan alone would make the dream of universal health care in America a reality, and that anything short of it simply preserves the much-maligned status quo. Fortunately for us all, this is not the case.
The US has been underperforming in health care for a long time. But now, there may be cause for optimism. Almost every Democratic candidate in the race supports moving to some form of universal health care system. Granted, a few holdouts are keeping their health care policy proposals vague (Joe Biden talks about building upon the Affordable Care Act, but hasn’t yet delivered many specifics), but nonetheless, this is something that would have been hard to believe just a few election cycles ago.
The actual debate now taking place within the party is how to get there from here. Some support moving directly to a single-payer system (Sanders, possibly Warren, and possibly Harris), while others would prefer to craft a multi-payer system with a public option (Yang, Buttegieg, Gillibrand, O’Rourke, and several others). As of now, the latter seems to be winning out.
While it is true, as Sanders likes to point out, that almost every other industrialized country on earth provides some form of universal health coverage to its citizens, it is plainly incorrect to imply that all of these countries have the same system. Some of the countries that Sanders regularly cites as examples for the US to follow do not actually have the type of single-payer system that his plan calls for. In fact, several countries in Europe and Asia have actually achieved highly efficient universal health care through a multi-payer system.
The idea of a “public option” has been floated for a long time, and works pretty much the way it sounds. If you like your health insurance, you can choose to keep it. Otherwise, you can opt into a federally funded public program that covers most health care necessities. During the first presidential debate, Pete Buttegieg referred to this idea as, “Medicare for all who want it.”
Literally speaking, this is truer to the idea of “Medicare for All” than a single-payer mandate. Medicare as we know it now is, after all, a public option for seniors, who also have the option to purchase supplementary insurance from private insurers.
With one popular variant of the public option, known as Medicare for America, those without health insurance, as well as those currently purchasing insurance via the ACA marketplaces, would automatically be enrolled in a version of Medicare. Lower-income beneficiaries would pay no premiums, while higher-income beneficiaries would pay some, as a means of controlling costs. Deductibles and out-of-pocket costs would be capped significantly lower than those available on the marketplace today.
Similar plans to create a public option have also been introduced. Colorado Senator Michael Bennett (now also a presidential candidate) co-sponsored a plan called Medicare X with Virginia Senator Tim Kaine last year. Under President Obama’s original plan, the Affordable Care Act also included a public option, but the provision failed to survive Congressional scrutiny.
There are plenty of reasons why a candidate might choose the public option route to Medicare for All as opposed to the single-payer variant: It would not require a tax hike for the middle class, gives Americans a choice rather than a mandate, and limits the risk of long wait times and other issues that sometimes arise in countries with single-payer. Polling data also shows that while a majority of Americans support some form of universal health care, that number drops significantly when it is stipulated that this would also involve a tax increase, or that it would require them to give up their current health insurance plan. And while some single-payer advocates argue that the new benefits would make up for the new taxes, that’s hard to say for sure.
There are good arguments to be made for the single-payer system’s advantages, as well. While achieving one would likely be harder for political reasons, these systems are arguably simpler and less bureaucratic. They automatically guarantee that everyone is covered, rather than requiring patients to opt in. They aren’t means-tested, meaning everyone is fully covered regardless of how much they earn. Private insurance companies’ ever-increasing premiums have caused enough grief that the impulse to do away with them entirely is understandable (although the extent to which they are responsible for increasingly higher hospital bills is debatable).
It is also important to note that even the staunch single-payer advocates like Sanders favor implementing a public option as a transition phase, allowing people to opt-in voluntarily before requiring everyone to enroll into one program (before he was a critic of the public option route, Sanders was a supporter, and to some extent, still seems to be one).
Several candidates, including Andrew Yang and Kirsten Gillibrand, have also made the case that introducing a public option would force private providers to lower their prices or risk going out of business. Either way, putting pressure on insurers and hospitals to lower prices by introducing an affordable competitor will be the first step.
It ultimately comes down to a question of priority. So far, 2020 Democratic candidates have been putting out a smorgasbord of ambitious promises, from universal basic income, to national job guarantees, to a Green New Deal. Taking a more pragmatic and cost-effective approach to achieving universal health care sounds even more sensible when paired up with other progressive policy goals, and the need to fund them all.
In either case, achieving universal health care would be a huge step for a country that has struggled with the health care question longer than most. Either path would be a significant improvement over the status quo, which allows many Americans to die needlessly each year, while many more become buried in extravagant medical debt.
Democrats (and anyone concerned with human health) ought be celebrating the fact that the need for universal health care has reached a near-consensus among 2020 candidates. If there must be a litmus test for progressive purity, this should not be it.