Options Memo on Universal Health Care Coverage

Written by Adam Knopsnyder

Reaching universal health care coverage in the United States has been a longtime goal for many presidential administrations and has come in the form of many different public policy options. However, given the current healthcare laws and programs that exist, there are two basic ideas that are being considered to achieve universal coverage: expanding the public option in the Affordable Care Act to cover any American who wants insurance or replacing the ACA with a true single payer healthcare system ran by the federal government. This post aims to analyze both policy options in terms of overall cost, ease of access, and comprehensiveness of the coverage.

The first option, which consists of expanding the public option in the ACA, is mainly concerned with keeping overall costs down, both in terms of federal government spending and individual health care expenses, such as copays, deductibles, and out-of-pocket spending.  In order to achieve this, the idea is to use the cost-effective methods of Medicare to create a comprehensive public option that competes with private insurance companies in the marketplace (Herzlinger & Boxer, 2019). This new public option would seem to be the exact same Medicare and Medicaid that is currently being used, however it would be financed very differently. Instead of having a system that charges the individual a very small amount, as in copays and deductibles, while incorporating the rest of the health care cost into the national debt, the new system would increase the amount charged to the individual in order to cover the overall cost of the health care (Herzlinger & Boxer, 2019). In turn, creating a public option that is not only economically comparable to private medical insurance, but will also help to drive down overall costs in the health care marketplace. Expanding the public option of the Affordable Care Act would give individuals the choice to stay on a private health insurance plan or to be a part of a public option that is economically sustainable, virtually ensuring universal coverage.

The second option to achieve universal health care coverage in the United States is to implement a government-run single payer healthcare system. A single payer system means that the only provider of health insurance in the US is the federal government, eliminating the need for private insurance companies, which would automatically cover all citizens at birth. Using a single payer system allows for the elimination of profit in the entire healthcare system, meaning the government can offer health care and prescription medications at cost to the American public (Harrison, 2018). In addition, administrative costs and billing expenses associated with the healthcare industry will become virtually nonexistent (Harrison, 2018). All of these things would help to lower total costs to both the federal government and individuals. When it comes to the cost of a single payer system, not only does the government have some control in keeping health care prices low in general, but the government can also pay for the care in a number of ways, like through taxation or charging low prices for medical care (Harrison, 2018). Implementing a single payer healthcare system in the United States would guarantee universal coverage and give the government the power to regulate the overall costs of health care, ensuring individuals could actually utilize their healthcare insurance.


Harrison, J. A. (2018, August 10). The Case for A Non-Profit Single-Payer Healthcare System. PNHP. https://pnhp.org/news/the-case-for-a-non-profit-single-payer-healthcare-system/

Herzlinger, R., & Boxer, R. (2019, October 10). The Case for the Public Option Over Medicare for All. Harvard Business Review. https://hbr.org/2019/10/the-case-for-the-public-option-over-medicare-for-all

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