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McGough ’23: The Public Option is the next step toward Medicare-for-All, for Now

More than ten years ago, the Affordable Care Act set out to realize a progressive dream that dates back to the New Deal: universal healthcare coverage. By expanding Medicaid eligibility and modifying insurance requirements, the ACA hoped to provide healthcare coverage for all Americans and drive down costs through an expansion of insurance pools.

However, for a variety of reasons, Obamacare has done neither. As of 2019, approximately 11 percent of Americans remain uninsured and the growing price of healthcare continues to outpace inflation.

Progressives, riding on a wave of post-recession, anti-corporate public sentiment, accused the act of failing by trying to do the impossible: effectively use private insurers for the public good. By mandating that middle-class Americans buy health insurance, the ACA gave insurers the power to raise prices with impunity ― so private insurers milked Americans dry.

This frustration with the private system has brought about the modern Medicare-for-All movement, an ambitious bid to cut private insurers out of the equation by guaranteeing coverage for all Americans with a government-backed plan. Regularly touted as a cure-all for America’s insurance woes, this proposal has sticking points that could make it more like single-payer snake oil. There are economic and administrative kinks that need to be smoothed out before the stage is set for socialized medicine — problems that can be solved by embracing public option health insurance.

As simple as it seems, Medicare-for-All is trying to solve a $1.7 trillion problem. America spends about $5,268 per person every year in private healthcare expenditures, totalling about 8.4 percent of the American economy. Extracting that volume of money out of the market in one fell swoop would be catastrophic. Moreover, 18 percent of the American economy is wrapped up in healthcare spending of one kind or another; to completely restructure it overnight is potentially disastrous. Even minor errors, when dealing with dollar amounts in the trillions, could cripple the American economy and healthcare system.

A whopping 573,000 Americans ― employees of private insurers  ― would quickly be on the economic chopping block. If Sanders-style progressives have their way and ban private insurance entirely, these employees could end up on the welfare rolls immediately. Communities like Minneapolis and Hartford that are presently the homes to major health insurers would be devastated as thousands of former employees cut back on spending, killing local businesses large and small. Many of America’s cities regained economic footing after the Great Recession by investing in service industries; to pull the rug out from under them now would be needlessly cruel.

The federal government’s track record on healthcare administration is also far from perfect. In 2014, a nationwide scandal broke after patient backlogs topped 100 days at several Veterans Affairs hospitals. At least 40 veterans died waiting for treatment at the Phoenix Veterans Affairs Health Care system. The Indian Health Service, a federal health system serving Indigenous populations which include some of the nation’s most impoverished communities, has long been woefully understaffed and plagued with preventable deaths as well. Clearly, the nation’s administrative capabilities need to be strengthened before moving to a fully public health system. Putting the lives of every American in the hands of the federal government is premature.

The current healthcare system must be carefully dismantled, not haphazardly demolished. So many people's lives and livelihoods are attached to the current system, however dysfunctional it is. Many wish to characterize Medicare-for-All as the ‘obvious’ or only way forward, refusing to acknowledge the immense complexity of remaking the system that dictates how one-fifth of all American money is spent. By painting single-payer care as flawless, progressives are shutting out millions of Americans who have real concerns about what this plan means for them. Just because a single-payer system is the end goal does not mean we are there yet.

Healthcare debates should acknowledge what progressive politicians know but do not say: There is no magic switch in Washington that can instantly and perfectly remake our current system into a totally public one. Our federal government is not ready, and moving too quickly would be devastating for workers and communities. Progressives should embrace an intermediary step between healthcare today and Medicare-for-All. The Public Option is that middle ground.

Originally intended to be part of Obamacare, the Public Option would allow Americans to buy into Medicare plans that are cheaper and cover more than comparable private plans. To bridge the gap for America’s most vulnerable populations, President Biden’s public option plan includes free enrollment for low-income citizens. Most Americans will migrate to these cheaper, superior plans over time, eventually making the Public Option a pseudo-single-payer system.

This migration will take time, but that is beneficial; rather than instantly killing private insurers, introducing the Public Option would shrink them bit-by-bit, giving workers and the economy time to adjust. Job markets can successfully absorb newly unemployed workers if they are laid off over time; not so much if half a million are unemployed at once.

The Public Option transition also gives the federal government time to stretch its atrophied administrative muscles. A total reconstruction of American healthcare likely requires a sprawling network of regional offices (the Social Security Administration currently has more than 1,200) which can be brought on one-by-one as more Americans buy in. This transitionary period also gives Congress time to restructure and regulate the federal Department of Health and Human Services, one of the most overstretched bureaucracies in Washington.

The Public Option can help ease skeptics of an entirely public health system from reluctance to acceptance. . It allows us to carefully transition out of our current system, rather than forcing a leap of faith into an all new one. By taking our time, we can ensure our economy and government can bear the load of a total remodel of one-fifth of American spending while reassuring those who are anxious about the prospect of a completely remade healthcare system.

Someday, when most Americans are utilizing the public buy-in, we can flip the switch with confidence and gracefully bring about single-payer health insurance. Until then, we should focus on embracing the Public Option and mitigating the effects of public medicine as they come.

Jackson McGough ’23 can be reached at Please send responses to this opinion to and op-eds to



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