What about the Public Option?

Proposals for the Public Option include (a) expanding Medicare to people over 55 and/or (b) allowing a Medicare (or Medicaid) buy-in. Could that be a bridge to a single payer system?


At first glance, the Public Option looks better than what we have now. However, a 2013 study from the Congressional Budget Office  found that it would have a minimal effect in reducing the number of uninsured Americans. One of the benefits of Medicare is that individuals are automatically enrolled once they qualify. Meanwhile, the failure of independent cooperatives in the insurance exchanges suggests what is likely to happen in the case of a Public Option. Moreover, the amount of political organizing that would be required in order to make the Public Option happen would be better spent in pursuit of a single payer system through National Improved Medicare for All. Currently, the Public Option is being advocated for by Democrats with high campaign contributions from insurance and pharmaceutical companies as an excuse for not cosponsoring single payer legislation. Further reading: Jacobin article from PNHP President-Elect Dr. Adam Gaffney

What is the difference between S-1804 (the Sanders bill) and HR-676 (Expanded & Improved Medicare for All)?


HR-676 is widely considered the gold standard of single payer legislation. As an organization, we have encouraged senators to cosponsor a Senate companion bill to HR-676. S-1804, while containing some improvements, falls short in the following ways:

  • Barriers to Long-Term Care: In Sen. Sanders’ plan, long-term care would be administered by the states only for low-income individuals, similar to Medicaid today. Long-term care should be provided to all as part of a national health plan. Nearly 10 million Americans need help with the basic tasks of living or help to maintain their independence. More than 80 percent of those who need care live in their communities, not in nursing homes, and nearly 40 percent of them are under age 65. 

  • Copays for some non-generic prescription drugs: Sen. Sanders’ bill requires patient copays on some non-generic prescription drugs. Research shows that copays of any kind discourage patients from seeking needed medical care, increasing sickness and long-term costs. Experience in other nations prove that they are not needed for cost control.

  • Delayed implementation: Delays add to implementation costs and allow opposition to prevent full implementation.

  • Allows investor-oned facilities to operate. For-profit health care facilities and agencies provide lower-quality care at higher costs than non-profits, resulting in both higher mortality rates and greater payments compared to not-for-profit providers. The bill also lacks global and capital budgets, which will allow for-profit facilities to drain the system.

  • Keeps complex payment schemes that increase paperwork, decrease time with patients and punish doctors who treat people in poverty. 


Do you support efforts to achieve single payer at the state level in Maryland?


As a project co-produced by Physicians for a National Health Program (PNHP) and Healthcare NOW, Healthcare is a Human Right Maryland comes out of a long history of advocacy for universal healthcare at both the state and national level. Currently, HCHR-MD is focusing our efforts on advocacy at the federal level, primarily HR-676, the Expanded and Improved Medicare for All Act. While there are a number of federal funding barriers that make a true single payer system impossible at a state level, we recognize the role of state-focused advocacy in educating the public on the benefits of universal healthcare.

Why aren't you fighting for incremental reforms, like the fixes the Democrats are proposing for the ACA?


The problem at the heart of our healthcare system is the for-profit framework that it operates in. Incrementalist solutions, like a Public Option, "Medicare Extra" or AmazonCare, do not address the massive amounts of administrative waste that keeps costs artificially high. More and more Americans are realizing that the only solution that makes fiscal sense, that covers everyone and that provides the comprehensive care we all deserve is National Improved Medicare for All.

Are you tied to a political party or political candidates?



Our organization is independent of political affiliation and we are not in a position to endorse political candidates. Medicare for All may be a primary issue for many progressive groups, but it is not a progressive issue. Our members represent diverse political allegiances. 

What positions are you taking in the 2018 Maryland legislative session?


You can read our statement on the 2018 session here

Is National Improved Medicare for All (NIMA) a "socialized" health system?


No, NIMA has more in common with Canada's Medicare than it does with government-run systems like the UK's National Health Service. As in Canada, care is financed through a government insurance system, but provided through the private sector, in addition to nonprofit hospitals and clinics.

Americans are already living under a socialized healthcare system. In our case, insurance industry profits are socialized through tax subsidies and high copays, while care is privatized. "Socialized medicine" is also an inaccurate description of most universal healthcare systems where businesses are not paying an average of $15,000 a year to contribute their share of the costs of an employee plan covering a family of four. Employer-provided insurance makes the costs of doing business prohibitive in many industries, while overseas competitors in many countries hold a competitive advantage.