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Sunday, May 9, 2021

Why the “Public Option” Cannot Work (and Single Payer Can)

Look at the pros and cons

By Dr Anita Kestin M.D. M.P.H

The current COVID crisis has unmasked and magnified the many problems in our present system for health care coverage. 

Many politicians recognize the need for change, but rather than advocate for what every other industrialized nation in the world has (Single Payer universal healthcare), they push for something that cannot solve our health care problems: the “Public Option.”

Our current system of paying for health care is:

  • needlessly complex, 
  • confusing, 
  • wasteful, 
  • tied to employment, 
  • administered by private (often for-profit) companies,
  • not universal, and 
  • onerous (for patients, providers, and employers). 

In contrast, Single Payer (Medicare for All) is a vastly superior method of payment for coverage: 

  • simple, 
  • universal, 
  • cost-efficient, and 
  • has the leverage to negotiate prices for drugs, devices, and services.

KEY POINT: Single payer gets rid of expensive middlemen/health insurance companies but leaves our current healthcare providers in place – however, with more freedom to deliver care.

The Public Option might seem like an attractive “middle ground” fix for our broken system of paying for health care. The Public Option, however, leaves in place all our current problems.

1. Continuing Skyrocketing Costs There is no compelling evidence that the Public Option will lower overall costs. Numerous studies, however, have determined that Single Payer would save money for all but the wealthiest individuals, in addition to lowering the price tag of health care for businesses and providers. These analyses even include one study1 done by the Mercatus Institute, a conservative think tank that set out to prove that Single Payer would be more expensive and wound up demonstrating the opposite!

2. Complexity The Public Option merely adds complexity to our overly complex, wasteful system by grafting another insurance option on to our current set of insurance plans.

3. Waste It has been estimated that 33% of all “health care” dollars spent in the US is not used for actual spending on health care.2

4. Unsustainability The Public Option would allow Private insurers to continue to “cherry pick” the healthiest members for their plans and to shunt sicker patients to the Public Option. This will make the Public Option increasingly costly to maintain and send it into a death spiral.

5. Insufficient Market Share to Negotiate Lower Prices In contrast to Single Payer, the Public Option would not have the leverage to negotiate effectively for lower drug and device prices that would be more in line with what other Western countries are paying for these items.

6. Limiting Choices Health insurers currently limit your choice of healthcare providers and services. Single Payer gives consumers back their ability to choose the doctors and hospitals they want. 3 The only choice the Public Option gives you is one more plan with inadequate coverage.

7. Delay implementing the only system that can work The near-certain death spiral of the Public Option plans merely delays enactment of Single Payer. The delay will continue to subject many to increased morbidity and mortality as insurance companies will be able to continue to deny care and consumers will continue to forgo needed care due to concerns about copays and deductibles.

8. Forcing health care providers to focus on insurance requirements rather than care. The Public Option will leave in place all of the insurance red tape associated with our current system. In contrast, Single Payer will allow doctors, hospitals, and pharmacies to focus on health care, rather than on reimbursement.

9. Injustice Single Payer coverage would provide everyone with the same coverage and thus will eliminate an important source of discrimination based on race, identity, and income.

10. Profit-Driven Decisions The Public Option would leave private health insurance companies accountable to their shareholders. Single payer would make the health care payment system accountable to the public – all of us!

Support single payer by: 1) using this simple form to email all your federal and state elected officials and 2) signing an open letter of support. For more information, email:


  1. Charles Blahous. “The Costs of a National Single-Payer Healthcare System.” Mercatus Working Paper, Mercatus Center at George Mason University, Arlington, VA, July 2018.
  2.; and
  3. March 10, 2021.

Dr Anita Kestin M.D. M.P.H is a member of PNHP-RI with an M.D. degree and an M.P.H. degree from Brown University.