Aiming at the Wrong (Public) Option

A recent Wall Street Journal headline read, “Democrats lower their sights on healthcare changes.” That’s inaccurate. Democrats have not lowered their sights. The target is the same: single payer, federal healthcare. Rather, they changed their weapon of choice, from their highly publicized, overt, and obvious takeover plan, H.R. 1384, named Medicare-for-All, to a covert, piece-meal strategy called “public option.”  Aiming at the same target, but with a silenced scatter gun rather than a howitzer. 

There is no question that total federal control of healthcare is the target. Every “fix” of healthcare has expanded Washington's control over both financing and medical decision-making. You are not in charge, Washington is. After all, Washington is responsible for healthcare, isn’t it? 

No, certainly not! Not if you recall the Tenth Amendment to the U.S. Constitution. 

Following the expansion of Medicaid eligibility under the Affordable Care Act, 68.8 million Americans, 21 percent of the nation, are now enrolled in Medicaid. Add 51 million in Medicare, 9.6 million in Tricare (federal military insurance), and 9.6 million in Children’s Health Insurance Program (CHIP) to see that 139 million Americans, 42 percent of the populace, have all their health care decisions made directly by Washington. 

The 179 million with private insurance have their health care decisions -- both what care, when, and how much expended -– made by insurance companies. As these companies and their contracted providers are governed by federal rules and regulations, Washington indirectly controls 54 percent of Americans’ healthcare. Indirect control in not acceptable to progressives. It must be total control, all Americans. 

Despite the complicit media’s heralding of Medicare-For-All (Democrats’ single-payer system) -– as the ultimate answer, the truth became apparent. Medicare-for-All would take away medical as well as financial decision-making from all Americans. It would strictly ration care, reduce availability of care, and would be incredibly expensive. Senator Bernie Sanders admits that his single-payer price tag could be $40 trillion. For comparison, the Affordable Care Act cost only $1.76 trillion, and the combined GDP of all nations on planet earth is $92 trillion.

Add the fact that the Medicare Trust will run out of money by 2026 and won’t be able to pay for seniors’ hospital care. Thus, Democrats know better than to push the name Medicare in any form. 

Hence the push for the public option, described as follows in the 2020 Democrat Party Platform. It “will provide at least one plan choice without deductibles; will be administered by CMS [Centers for Medicare and Medicaid Services, a federal agency], not private companies; and will cover all primary care without any co-payments and control costs for other treatments by negotiating prices with doctors and hospitals.” If you read the Medicare-for-All bill, H.R. 1384, the similarities become obvious. 

Provider groups, insurers, pharmaceutical companies, and hospitals, oppose the public option because it will cut into their bottom lines. With Washington “negotiating prices,” i.e., payments, negotiation becomes a take-it-or-leave-it affair. Imagine a soldier with a rifle negotiating with a B-52 bomber. The power disparity is apt for a doctor or medical facility negotiating payments with the federal government.

Private insurance companies, pharmaceutical manufacturers, medical centers, and doctors’ offices all depend on premiums or payments for goods or services for their income. When their costs -– for example contracts to provide care –- are greater than payments from Washington, the insurance company, private practice, or hospital is forced out of business.

This is why one in four U.S. rural hospitals are in danger of closing. Roughly 60 million Americans live in rural areas where they have only one medical facility. Between 2010 and 2020, 136 rural hospitals have already closed. In the 1960s, Texas had more than 300 rural hospitals. Today, 158 remain open. When costs are greater than government-mandated payments, what choice is there? These closures left millions with no readily available medical care. 

The public option would be supported by taxpayer funds, effectively a limitless source of revenue. Thus, healthcare spending by the federal government can never exceed revenue because Washington can always raise taxes and/or print money. This allows the feds to price public option insurance below the cost-to-stay-in-business of private insurance companies and drive them out of the market, leaving Americans with only one option: federal health insurance.

Washington’s ability to engage in such predatory pricing combined with the power to dictate (they will say negotiate) payments to doctors will quickly eliminate all private practice in this country. In fact, Democrats’ single payer plan calls for a 40 percent reduction in payments to physicians. As private physicians’ overhead is more than 60 percent of revenue, the effect of such a federally mandated loss of income is obvious.  

Federal price controls in Democrats’ public option/single payer system on drugs will suppress research and development activities by Big Pharma. The result will be no new medical miracles.

Hence, while they continue to aim at single payer, it is disguised as public option. Hopefully, Americans will see through the official lies, push aside the curtain (recall the Wizard of Oz) to expose the deception, and see the public option is another attempt to accomplish federal healthcare.

One should never identify a problem without offering an answer. Since the public option will not fix healthcare, what will?

To cure our sick healthcare system, remove Washington’s unconstitutional domination and return control where it belongs, with We the People. Evidence shows that this strategy, called StatesCare and market-based medicine, will work. 

Photo credit: Molly Adams CC-BY 2.0 license

Deane Waldman, M.D., MBA is Professor Emeritus of Pediatrics, Pathology, and Decision Science; former director of the Center for Healthcare Policy at Texas Public Policy Foundation; and author of the multi-award-winning book Curing the Cancer in U.S. Healthcare:  StatesCare and Market-Based Medicine

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