As someone who owns a therapy company, I understand why a public option would be far less effective than a single-payer healthcare system. This isn’t a matter of speculation; this is real-world experience dealing in a market with private and public insurance clients. Hopefully, this will help someone understand why many doctors support single-payer. 

The problem with a public option as proposed by centrist politicians is that it would have to compete with private companies to provide basic/core healthcare services. Any public option without some unique scope would be at a disadvantage. When private companies compete with a public option to cover a certain healthcare service, they can improve their access to healthcare providers by offering more money for it. 

In my example, we own a company that provides pediatric therapy. Because most people can’t afford these services without insurance, our revenue is based on what insurance companies will pay. If someone uses a public healthcare option such as Medicaid, we get paid a lot less for some services. They offer much lower reimbursement rates, and they are always understaffed so anything administrative is terrible. The public option is always at risk of under-funding because people don’t have to pay that much into it – and why should they since they have other insurance? 

On the other hand, our clients with the best jobs have insurance through private companies that pay higher reimbursement rates. Sometimes they offer nearly twice as much for a similar service. That works out great for the members of that insurance company, because healthcare providers are more likely to try dealing with their insurance. For the public option users, it is the opposite: there isn’t enough incentive to serve them at all.

So healthcare providers end up seeking people who will privately pay for services. After that, they work with whatever insurance companies are easiest to deal with, and pay the most. Providers may put a specific cap on how many ‘medicaid’ clients they service. These clients end up further down on waitlists, waiting much longer for services, if they ever get them.

What’s a better idea? Have universal care for any services that are considered critical. This does not mean you eliminate the private insurance industry, but it does mean relegating them to minor or boutique services, or certain upgrades i.e. France. The universal option must serve everyone so that there is a reason for everyone to invest in it. Everyone pays, everyone benefits.

Universal coverage is also better for small businesses. If we tried to hire full-time staff, we’d need to provide expensive health insurance, making it hard to compete with huge companies that have better deals for insurance plans. We would much rather pay into a system that covers everyone already, allowing small businesses to better compete with corporations. 

My company provides pediatric therapy that can have a massive impact on the rest of a child’s life. We have witnessed parents in utter crisis over the difficulty in getting services, and it can be heartbreaking. Often, it is because (1) their insurance isn’t ‘good’ enough, and (2) there aren’t enough therapists in the area. But the local providers can’t grow their businesses due to the insurance system. 

This current system won’t allow us to fix our problems. We need something better than the ACA (or the public option they so quickly removed from it). The ACA is highly susceptible to political attacks because it doesn’t control costs and it isn’t universal like social security; it still leaves over 25+ million people without coverage. The uninsured number is, of course, rising because the ACA can be dismantled piece-by-piece by pro-business conservatives and centrists. But the ACA is better than nothing and absolves centrists of guilt without disrupting the status quo.

So many questions. Is this really the best we can do? Do Americans really hate taxes so much that they can’t imagine the overall cost savings? Why and how are we still having a debate about whether basic healthcare should be a commodity when all other developed countries have moved past this? 

Maybe we’re still figuring out whether we actually give a crap about each other. I hope we decide soon.