Guest Commentary: Why a public option won’t work

Dr. George Bohmfalk
Guest commentary

Health care will be a major topic in the upcoming Democratic presidential debate. Only two of the candidates — Sanders and Warren — support real Medicare for All. The rest waffle around some lesser, politically more palatable version, like Medicare for All Who Want It or other euphemism for a public option. You will hear them insist that, while they agree on the need for universal healthcare, we should get there incrementally, not in one fell swoop.

They are all wrong.

Lincoln didn’t end slavery incrementally, nor did we incrementally become a nation or defeat Hitler. Some things require bold action to help the most people. Medicare for All is one of those things.

There are two fundamental reasons that a public option cannot work.

The big, solvable issue in our health care system is the 30% of every health care dollar that is squandered on administrative overhead — paperwork, the preapprovals, denials and appeals that are an integral part of myriad for-profit private insurance companies. That’s around $1 trillion every year. Only a single-payer system like Medicare for All can cut that trillion dollars in half, by eliminating that bureaucratic waste. That half — $500 billion — can be redirected to providing comprehensive health care to all Americans. It’s not free. We’ll all pay for it in taxes, which for most of us will be less than what we’re currently spending on premiums, copays, deductibles, and other health care expenses. We’ll pay less in the end for more health care, for everyone.

A public option cannot save that $500 billion, nor can it reduce health care costs. It will only add one more choice of insurance provider to the current complex mix. Most of us neither know nor care which company provides our insurance. The choice we really care about is choice of doctors and hospitals. Most private insurers restrict that choice, to maximize profits. They also restrict our access to health care by imposing deductibles and copays, which many of us can’t afford. Medicare for All offers free choice of doctors and hospitals, with no deductibles and copays. What more choice can anyone want?

The other fatal flaw in a public option is that it will likely become the insurer of last resort to the sickest and oldest among us. The insurance playing field will be anything but level. As deficient as they are, for-profit insurers will cleverly market themselves to the young and healthy, leaving those who use more healthcare to the public option. Its costs will balloon, dooming it to fail, to the delight of for-profit companies.

Sanders and Warren understand this. They understand that fear of change is what causes people to think that they would rather keep their present, inadequate, expensive insurance plans. They understand that most people are eager to turn 65 and trade their employer-provided plans for Medicare. They understand that everyone would be better off with Medicare for All, and that a public option simply won’t get us there.

Incrementalism is often a valid approach to change. Allowing people to choose between keeping their current restrictive plans or a Medicare for All option sounds reasonable, but it just won’t work. As with emancipation, the Declaration of Independence and World War II, this is a time for major change that will benefit the most people.

It may seem scary, as all change does, but it’s the only way to get all of us the health care protection we deserve, at lower cost than we’re paying now. Rather than fear it, we need to understand and embrace Medicare for All.

Dr. George Bohmfalk, a retired neurosurgeon who lives part time in the Roaring Fork Valley, is a member of the Colorado chapter of Physicians for a National Health Program. He may be reached at