Vice-President Biden is proposing that the government offer people a public health insurance option, if he is elected President. A new Data for Progress poll finds that a large majority of voters support the government offering a public health insurance option. That said, there’s not yet a clear definition of how a public option would work.
The concept of a public option was first raised in the last wave of health reform. It was based on the notion that private health insurers were not meeting people’s needs, either in terms of access to care or affordability; they offered restricted provider networks and charged high premiums and out-of-pocket costs. What’s worse, many seem to indiscriminately deny care because they profit when they deny care. But, no one knows when they enroll in a plan, the extent to which that health plan inappropriately denies people care.
Congress ultimately enacted the Affordable Care Act, which offers government-administered private health insurance. It opted not to offer people the choice of public health insurance, provided directly through the government, like traditional Medicare.
Unlike private health insurance, which generally is accountable to shareholders, public health insurance, like traditional Medicare, is accountable to the public. It relies on the government’s leverage to control costs and to ensure people access to providers across the nation. It does not profit from denying care, and is designed to “spread risk,” so that people with costly conditions are not burdened with high health care costs.
As the Biden-Sanders Unity Task Force spells out. Americans who opted for public health insurance would pay the government for their coverage. And, the Data for Progress poll indicates Americans are fine with that. Nearly half of voters, a plurality, say they would be willing to pay the government directly for public health insurance (49 percent).
Members of Congress are still considering how to design a public option and whether it should be available to everyone. Americans want public health insurance to be available as a choice to everyone (45 percent). It should be. Private insurers, no matter how many there are in a given market, do not engage in meaningful competition–competition that drives value by lowering health care costs and improving quality.
Americans also support automatic enrollment in public health insurance for people who do not have other coverage. The novel coronavirus pandemic has revealed the fragility of our employer-based health care system. You lose your job and, often, your health insurance as well. People who leave their jobs continue to need protection from health care costs and do not want to worry about having health care coverage.
What’s most interesting is that two-thirds of Americans say they would get their health insurance through a government-run plan. Fewer than one in five voters say they would not get insurance through the government. Americans increasingly realize that they need an alternative to private health insurance, which is often unreliable and unaffordable.
Lest there remain any confusion about the definition of a public option–the choice of public health insurance–it is not the same as the choice of private health insurance through the government. Americans already have government-administered private health plan options in the state health exchanges. These health plans do not have the power to rein in costs; they do not offer a broad provider network; and, they answer to their shareholders first and foremost.
The question becomes whether Democrats in Congress, much less Republicans, are prepared to acknowledge that if they enact a public option it should piggyback off of traditional Medicare with an out-of-pocket cap and prescription drug coverage woven into the benefit. That would put it on a level playing field with private health plans. Only this improved traditional Medicare offers people the guarantees of easy access to care from the doctors they want to see at a price they can afford.
Here’s more from Just Care:
- Biden-Sanders Unity Task Force recommends incremental health reforms
- What are the major differences between Medicare for all and a public option?
- Seven reasons commercial insurance cannot meet our health care needs
- Four things to think about when choosing between traditional Medicare and Medicare Advantage plans
- Coronavirus: The importance of health care proxies
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