The United States currently spends too much on health care for too little reward. Despite the high spending rates, Americans are generally less healthy than other people in a number of different measures, including mortality. Recent studies, cited in the New York Times and the American College of Physicians (ACP) report have shown that coverage reduces mortality rates, thus justifying policies that move towards universal coverage over those that reduce it. In addition, improving health care coverage helps health care providers, as it ensures that they are paid by insurers. This has helped keep hospitals open, especially in underserved areas where patients often can't afford the full cost of care. Therefore, expanding coverage is an important policy goal for improving United States public health and mortality statistics. 

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In evaluating ways to achieve universal coverage, the ACP determined that the single-payer system or a public option would be ideal. While I believe a single-payer system would be most beneficial, as everyone would have equal benefits and the costs and confusion of administration would decrease significantly, the successful implementation of such a system poses various difficulties:

• Resistance due to the perception that single-payer health care is government overreach

• Resistance to tax increases that would replace premiums

• Reduction of competition could reduce innovation in health care

• 67% of Americans currently use private health insurance- there would be a huge disruption moving such a quantity of people to a single plan

• Government plans tend to pay providers less than private ones. As a result, there could be a decrease in the number of physicians and an increase in wait times for care

• Possibility for extreme cost

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A public option does not eliminate all concerns. However, it is a more moderate approach with more political support, and it could serve as a transition to a single-payer system if necessary. Some of the greatest benefits of a public option include:

• Allows the large portion of Americans that are satisfied with their private health insurance to keep the same plan

• Increases coverage without the same disruption of the single-payer plan

• Would reduce premiums in areas with limited competition between private health insurance companies

• Allows employees to switch jobs or move states without worrying about changes to their health care plans

• Includes opportunity for expansion to a single-payer system if the public option proves more popular with employers and consumers

• There are 2.5 million people who are eligible for the ACA Medicaid expansion, but whose states chose not to enact the expansion. These uninsured people would benefit from an affordable public option other that Medicaid.

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In order to create a public option that is truly affordable and beneficial for coverage, there are some necessary features:

• Cannot follow the current Medicare payment system- if large numbers of people enroll in the public option and pay Medicare rates for care, physicians could suffer financially (especially primary care physicians and cognitive specialists, who are undervalued more than other physicians under current Medicare rates). As a result, less physicians would be part of the public option, undermining its efficiency. Due to the disproportionate effect on physicians who provide preventive care, this would also be harmful to overall health goals for the nation.

• Expansion of subsidies- many people who currently have health insurance still cannot afford care because of deductibles. In order to remedy this, cost-sharing subsidies should be expanded.

• Allow employees to purchase the public option even if their employers offer employer-sponsored insurance. Currently, people eligible for subsidized Individual Market plans are unable to purchase them if their employer offers insurance, which restricts their options. A public option plan should be available to anyone.

• The costs of a public option would also require employers to cover part of the public option premiums for employees that choose the government plan over they employer-sponsored plan. A public option policy should also allow employers to offer the public option as their employer-sponsored plan. This provision is especially necessary if the public option is to be used as a transition to single-payer health care, as it has the potential to greatly increase the number of public option enrollees.

• Create an equal field for competition by ensuring that both the public option and private plans follow the same standards for benefits and quality of care. 

• Make health insurance mandatory.

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Both liberals and conservatives have valid arguments against the public option, a few of which are summarized below. 

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Single payer systems reduce prescription drug prices more and would save more by reducing the complicated administrative efforts of a multi-payer system.

These are both valid complaints. However, a public option is less disruptive to the majority of Americans who currently have private insurance. In somewhat confusing polls, Americans have been shown to dislike health care costs, view the system as flawed, and yet still be happy with their insurance. A public option is better at adhering to this stance, as it maintains good private health insurance plans while addressing systematic flaws, such as high cost- sharing and unequal service. 

The regulations on insurance benefits and the mandate for coverage force people to purchase plans they don't want- it is a violation of freedoms and has too much government involvement.

Although the individual mandate would force people to purchase insurance, it is important to achieving universal coverage. The World Health Organization has said that voluntary participation makes universal coverage impossible- all the nations that have universal coverage also have some form of mandatory participation. The premise of the public option policy is that universal coverage is the best way to improve American health, and so it follows that some kind of mandate is important to health as well.

 Although the government would be involved in a public option, this is preferable to the current system, where for-profit insurance companies are heavily involved. The advantage of government participation is that it reduces the control of profit-oriented bodies in the protection of health. The government is also already heavily involved in health care. This doesn't necessarily justify government involvement, but it does show that a public option would not be a huge extension of government overreach.