Charlie —

Thanks for your input. A few comments:

You say, “ Any ‘public option’ that is sufficient (i.e, full coverage free at the point of service) would immediately put insurance companies out of business.” I am not sure about that, for two reasons.

First, no country has ever tried a plan that included “full coverage free at point of service.” Even countries like UK, Canada, New Zealand, and others that have the world’s top-rated health care system have some restrictions of services that are covered free at point of service, and some requirements for copays, deductibles, or other cost sharing. (See here for details.) As a result, we cannot really be sure what would happen if such a reform were attempted in the United States, for the first time anywhere.

Second, even in countries that have top-rated comprehensive national health systems (like those named above), there is a role for private insurance and private practice of medicine. For example, in the UK, which probably comes closest to “full coverage free at point of service,” the Commonwealth Fund reports as follows:

Private health insurance: In 2015, an estimated 10.5 percent of the U.K. population had private voluntary health insurance, with 3.94 million policies held at the beginning of 2015.5 Private insurance offers more rapid and convenient access to care, especially for elective hospital procedures, but most policies exclude mental health, maternity services, emergency care, and general practice.

Sec. 303 of Sanders’ Medicare for All bill (S 1804) explicitly permits such a parallel private system. It is impossible to say how many people would take advantage of it, but I think we can be fairly sure it would be greater than 0 percent.

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Economist, Senior Fellow at Niskanen Center, Yale Ph.D. Interests include environment, health care policy, social safety net, economic freedom.

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