During the debate surrounding the Affordable Care Act, then Independent Connecticut Senator Joe Lieberman rose to notoriety among the American left when he torpedoed a public option, which would have allowed some, if not all, Americans to buy their way into medicare or medicaid. Lieberman was a pivotal vote and many viewed the public option integral to the success of the Affordable Care Act (ACA). It was a fundamental piece of the architecture that would become the ACA, but the right viewed it as a convenient bridge to socialized medicine and eventually Lieberman gave into Republican pressure to sink the measure. (And now he gets to show up on Fox Business whenever he wants, good shit).
That’s a very oversimplified version of the story that lead to the death of the public option, but with Medicare for All on the policy agenda, it’s probably time for Republicans to revive it, lest they get saddled with the spooky socialized medicine they wanted to kill in the first place. Given the sorry state of American healthcare a public option should be given some serious thought and not by those on the left, but those on the right who want to prevent a swing to single payer.
The lack of a public option significantly impairs the Affordable Care Act, both in its ability to keep premiums lower for older and sicker recipients and in its ability to ensure multiple plans in rural areas. Both of which are problems crippling the Affordable Care Act that a public option could solve easily. With enough time a public option very well could lower costs as well, much in the same way Bernie’s Medicare for All plan wants to, basically by putting more people on the government healthcare program and allowing increased bargaining power for pricing therein. If Republican lawmakers were interested in actually solving the problems facing Americans in the realm of healthcare, they would be wise to seriously consider a public option.
First the public option allows older sicker people an escape from inevitably increasing premiums, putting them into the heavier subsidized pool of healthcare that is medicare/medicaid. Furthermore, healthier older people looking for a lower cost plan would be able to pay into medicare, potentially shoring up the program for decades to come. It would also allow younger people on the program who might not pay into it now, adding even more long term flexibility.
More pressing though is the issue of rural counties with one or no insurers on the marketplace. A public option would circumvent this problem by creating a lower bar for competition and guarantee at least one possible plan for everyone in the country. It might also lower premiums by allowing younger, healthier, people to be placed on insurance plans that offer something similar to the care they might actually use, as companies would shift away from using young customers to subsidize older sicker people who have now been moved to medicare.
There is a reason the public option was included in the plan to begin with. While the potential impact a public option could bring is speculation, so was passing the Affordable Care Act without such a measure included. Now the Affordable Care Act is struggling and instead of letting the marketplace collapse, Trump and the Republican Party would be wise to consider a public option to solidify the Affordable Care Act. Not only because it’s good policy, but because it could prevent a move to single payer, which is exactly what keeping the public option out of the equation was meant to prevent in the first place. While I personally think single payer and specifically Bernie’s proposed Medicare-for-All plan is the way to go, if I was a Republican lawmaker who is staunchly opposed to government healthcare, I’d fall in line behind a public option.
On paper, single payer and a public option fix a lot of the same problems through significantly different mechanisms. Both aim to reduce costs by increasing the pool of people in a given insurance program, one by effectively making itself the only insurance program and the other by allowing people to buy into predetermined healthcare options. In the case of the United States both a single payer system or a public option would both probably use the medicare program. Single Player comes with the hurdle of entirely restructuring the insurance industry, while a public option allows people to keep their insurance, as long as it remains competitively viable anyway. This difference alone is exactly why the public option should be considered the conservative mechanism to solve America’s healthcare woes, just as the Affordable Care Act once was.
The fact is, currently Republicans have no real fix for American healthcare. Republicans have no real plan to reduce high prices for both prescription drugs and medical procedures. There is no Republican plan to reduce premiums or out of pocket costs for the average American. There are plans to cut funding from medicare, medicaid, and repeal the taxes that serve as the bedrock for the Affordable Care Act’s insurance subsidies and while many Americans may agree with those cuts in principle, when asked what they want from their healthcare system, these cuts and the lack of a broader Republican plan run diametrically opposed to what most Americans claim they want. Namely cheaper, more accessible care, from the same doctor or clinic they receive it now.
In poll after poll Americans indicate they want lower prices, lower premiums, and more coverage for their neighbors. Something both Republicans and Democrats have campaigned on for decades and have consistently failed to deliver. Still, there are policy options that might usher in such changes and as it stands now a public option is looking like the most conservative route to actually solving these problems. Medicare for All is the alternative it seems, as almost every Democrat supports it, at least in theory.
If Republicans are as worried about socialized medicine as they claimed to be when they killed the original public option they would be wise to reintroduce that dead provision. Lest Americans veer into the spooky world of socialism and adopt a single payer system, in which case Republicans will get exactly what they claim they don’t want. All because they couldn’t propose policy that might actually solve the problems many see in the American healthcare system.