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- cross-posted to:
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The public option sounds like a step toward universal health care, but it’s really a delay tactic. The latest versions would force public plans to mimic private insurers, while the fight over the arcane details buys the industry another decade or two.
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The difference between a vampire and a bad health care policy idea is that vampires jump out of their coffins and drink blood at sunset. Undead health care proposals emerge from think tank closets and suck the life out of useful ideas when the sun rises on a national health care debate. As public fury at exploding costs and deadly corporate claims denials boils over into historic Democratic election gains, can someone please find a wooden stake for the public option?
Improved and expanded Medicare for All would give everyone full coverage at much lower cost than the combined private premiums, taxes, and out-of-pocket payments that are eating up family income today. But it violates a cardinal rule of federal politics: never do anything that causes corporations or the ultrawealthy any pain.
Instead, corporate Democrats wanting to be seen “doing something” about the imploding US health care system have long peddled a vague public option notion because it sounds like the marriage of a big noncorporate vision (it’s public!) with competition and freedom of choice (it’s an option!). Liberal nongovernmental organizations (NGOs) and pundits revived its rotting corpse in response to pro–Medicare for All candidates’ primary victories and Tuesday night’s stunning results.
It’s a perfect nonsolution to our three-headed crisis of health care cost, access, and quality. Nobody knows what a “public option” is because there’s no common definition and nothing like it has ever been seen in the wild, so it can be anything weaselly politicians want it to be. It needs to be put out of our misery.
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The worst thing about public optionism is enduring smug lectures that Medicare for All is a political fantasy that could never happen from people promoting a vague, unworkable idea now enjoying its twenty-third year of politically viable nonexistence. Yet The American Prospect casually assumes that a series of essential Medicare for All elements against which the industry will fight like rabid dogs can easily be grafted onto a public option.
Health care is a public good. Pretending that having government act like a health insurance corporation will do anything useful is absurd. Let’s kill this putrefying political monster right now.



Before going further, I’ll note that these two things aren’t mutually-exclusive though. I think Public Option is a stepping-stone to Single-payer, and just like the benefits ACA brought with it over the former failed system, it’s a small step of progress which almost inevitably leads to everyone jumping ship to national insurance anyway in the long-run. Whether we can sell to the electorate going straight to the end-goal of Single-payer is the real question.
Last year, PEW did a survey on where people stand on this and if you assume Mix government / private programs suggests public option then Single-payer is overtaking it by 4 percentage points. Keep pushing until we’re forced to settle.
Forget the meta-talk about, “Should we go for it or not” and do the groundwork of pitching it to people across all states as to why it must be the goal from the outset. Convince the people, and then the representatives will follow.
Congress doesn’t give a shit what constituents think. Multiple studies show popular opinion has almost zero impact on legislative action.
Those may be dated studies?
While imperfect, especially when sentiment grows so strong that impacts their own electability (e.g., AI data-centers, Iran War, Epstein Files), they can shift. It does have some impact.
No matter how you slice it, either way if public sentiment isn’t there, then it’s definitely not happening.
In the same way that negotiating with tapeworms has some impact on anti-parasite treatment outcomes.
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