Reports from Kaiser Health News and The Washington Post among others indicate a revived effort to enact “Public Option” proposals.

Unfortunately, these proposals do not solve the fundamental problems of cost and equity plaguing our dysfunctional, for-profit insurance based healthcare financing system unlike single payer.

Single Payer vs. Public Option: A Comparison by Healthy California Now

This chart shows why a public option will not solve any of the fundamental problems plaguing healthcare in the US – particularly the escalating costs paid by individuals, businesses and government and the long-standing inequities exposed by the COVID pandemic. Adding to the complexity of the multi-payer system is a diversion from the urgent need to guarantee healthcare to all healthcare.


Single Payer

Public Option

Covered population

all US residents automatically from birth

not universal; would leave millions uninsured and underinsured


all necessary services:

  • doctors
  • hospitalization
  • outpatient care
  • lab and imaging
  • dental, vision, and hearing care
  • mental and behavioral health
  • reproductive care, including abortion
  • long-term care
  • prescription drugs

more restrictive (similar to private insurance or Medicare)


free choice of providers

perhaps, if like traditional Medicare

no, if like Medicare Advantage


resources allocated to serve community needs

no change in profit-seeking resource allocation


for individual: no cost-sharing

for program: no administrative waste

CBO estimates savings of $650 billion annually

for individual: current cost-sharing (deductibles, etc.) remains

for healthcare system: adds complexity, maintains administrative waste and forgoes savings



continues current regressive financing

Sustainable cost

cost-controls for fees, Rx drugs, health planning; stable budgets with transparency

lacks global budgeting, Rx price negotiation, transparency; may have adverse impact on Medicare trust fund



universal risk pool provides most secure fiscal foundation

smaller risk pool vulnerable to adverse selection

Transparency and accountability

publicly governed, transparent and accountable

lacking if Medicare Advantage model used

Linked to employment

no – takes healthcare off the bargaining table

workers have freedom to change jobs

possibly (depending on program)

employers will decide on workers’ eligibility and could continue to set rules in non-union workplaces

Like Medicare?

yes, except improved: comprehensive benefits, no out-of-pocket costs

inferior: without guaranteed enrollment and choice of provider

Political feasibility


expect strong opposition from private insurance industry

Thanks to PNHP (with some HCN additions)