SEE 1787'S PLAN OF ACTION HERE
For decades – and especially when President Obama got serious about passing the Affordable Care Act (ACA) fifteen years ago – every time the highly controversial and heated debate over the public option and single-payer health care was brought up, it was immediately shut down by Republicans, mainly because of the “Socialist” connotation associated with them. The inherent laziness in this approach drives us C R A Z Y!
Over the years, we have taken a hard look at both the public option and single-payer health care and, based on the facts, neither of these ideas is the way to go (more on this later). That said, although these are not solutions we ultimately landed on, we learned a ton about the health care system from researching them, and we're convinced this newfound knowledge made 1787’s health care plan stronger and more comprehensive than it would have been otherwise.
Making decisions based on nothing more than an ideology makes zero sense. Why in the world would we take any potential solution off the table without fully checking it out, simply because the supposed philosophy behind it makes us uncomfortable?
We admit that, before doing research, we always associated the public option and single-payer health care with the Soviet Union and, being good capitalists, both concepts made us plenty nervous. But this reaction had to be based on a preexisting bias because, until a few years ago, we didn’t know what the heck they even were.
Let’s please, please, please not allow preconceived notions and past prejudices to prevent potential progress. We have lost the luxury of making uninformed, snap judgments about pivotal issues. We don’t know about you, but we'd rather be called a Socialists than stupid.
Let’s start this section off with a bang. Is health care a right or a privilege? In our minds it’s neither. It’s a means (the best way to deliver high-quality, low-cost health care) to an end (living the healthiest life possible). Whether we get good health care or bad health care is a vital component of all our lives, and we want every American to get the highest quality care.
But the right v. privilege debate misses the point. If you go straight to the founding documents, health care is not a right. The Declaration of Independence says that we all have “unalienable rights, that among these are life, liberty and the pursuit of happiness,” but that’s not the U.S. Constitution – and using that phrase to say we all have a right to health care is a stretch anyway. Sure, the purpose of the actual U.S. Constitution is to “promote the general welfare,” but the word used is promote, not provide.
The two documents that inch health care more toward being an actual right are the United Nations Universal Declaration of Human Rights (“everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care”) and World Health Organization resolution 58.33 (which speaks to equity in access, plus financial-risk protection to ensure that the cost of health care does not put people at risk of financial catastrophe).
But those still don’t get us to every single American has the right to free health care, which is pretty much what people mean when they say health care is a right (meaning, people who say this typically don’t mean the government should simply acknowledge that health care is one of our Constitutional rights – they mean the government should be responsible for giving health care to each of us).
It’s 1000% understandable this issue sparks heavy-duty emotions because, at its core, it’s about our loved ones who have life-threatening cancer, heart disease, or things like high-blood pressure that can cause massive strokes. It’s about our children who have severe asthma or diabetes or other potentially debilitating health issues. It’s about desperately wanting the ones we love to have the highest quality of health care, and to be with us – pain free – for as long as they possibly can.
Again, we want every American to have the very best health care. But when speaking of how to best deliver high-quality, low-cost health care, the stronger argument is one that moves beyond emotions and goes straight to dollars and cents.
The principle at the heart of the health care debate is not about our rights. It’s about the best way to provide universal health coverage – which means that, as the World Health Organization puts it, “all people and communities can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship.”
On this point, we are an emphatic YES!! One thing the Constitution absolutely provides us is the freedom to build a country we can all be proud of. America will never be a country that abandons citizens in need and thank God for that. Because of this gift, we need to design smart programs that give us the biggest bang for our buck. Because – hear this loud and clear – we are spending the money anyway.
With so many issues, if we allow emotions to get in the way of common sense we will lose our way. In a country with 335 million people, the challenges we face in health care are linked in intricate ways and, therefore, our solutions must be developed collectively as opposed to individually.
We realize that we Americans cherish our individual freedoms but, when it comes to health care, our fortunes are completely tied to one another. For good or ill, we are all in this together.
As we move forward, it’s critical that we forget ideology and just do the math. First, let’s address the elephant (or, in this case, donkey, LOL, see what we did there?) in the room: Medicare for All, single-payer, and/or a public option.
Let’s get our terms squared away.
Medicare for All – All Americans would be covered under the government-sponsored insurance program that currently serves Americans 65 and over.
Single-Payer – A term typically used to describe a system run by the federal government: Everyone gets health care from one insurer, and the system is generally paid for by taxes.
Public Option – Sort of a mix between single-payer and what we have now (where only certain citizens qualify for programs run by the government). With a public option, more people could qualify for government-run programs (i.e., Medicare or Medicaid) if they wanted to. These could replace private insurance plans for people, but private insurance plans would still exist.
None of these are the way to go for at least four reasons:
Every one of these alternatives demand massive middle-class tax increases. Anyone who says differently is being dishonest. Very few things in this world are free, and health care certainly isn’t. If you are getting “free” health care, you are paying for it through increased taxes. That’s just a fact. Taxing the rich is not enough to cover this divide. Not even close.
The reason taxes would have to increase is that these options are insanely expensive. During the 2016 presidential campaign, the Urban Institute, a research institute, said this about Senator Bernie Sanders’ Medicare for All plan: “In total, federal spending would increase by about $2.5 trillion (257.6 percent) in 2017. Federal expenditures would increase by about $32 trillion (232.7 percent) between 2017 and 2026.”
To put this into perspective, overall spending in the entire FY2025 U.S. Budget – literally everything we spend money on – was $7 trillion.
Two years later, a research team led by Charles Blahous – a senior economic adviser to former President George W. Bush and a public trustee of Social Security and Medicare during the Obama administration – found that Bernie’s proposal would increase federal spending by around $32.6 trillion over its first ten years.
These options would all disrupt private insurance contracts, which would affect the coverage of 215 million Americans.
Patient choice would decrease big time, and doctors’ salaries and hospital revenue would drop significantly. Believe us when we say we don’t want this to happen. Yes, we must control costs, and how much we pay doctors and hospitals are certainly not immune from hard choices. But these decisions must be strategic and part of a broader plan. The last thing we want to do is unleash a bunch of unintended consequences by pulling the rug out from underneath everyone and everything all at once.
Cutting doctors’ pay, for example, incentivizes them to choose higher-paid specialties over lower-paying jobs in primary care. This one act alone could lead to fewer available doctors for the sickest patients, plus would mean longer wait times and less time with the doctor when you finally get into one. With challenges like this, we must be super careful that every issue is part of a smart broader strategy... and be very mindful of #TheButterflyEffect!
So, where should we go from here?
Answer: We should stick with – but vastly improve – the Affordable Care Act (ACA) structure…. the exact opposite of what the Republicans have done for the past 15 years.
We already have the ACA – it’s here, it’s a reality, and American companies have spent billions to comply with it. So, we need to make it the smartest health care policy we possibly can. The bottom line is that we have the architecture of something that can work, so starting from scratch makes no sense.
Although the initial ACA structure was janky – the final version of the legislation was a complex hodgepodge of private insurance and government-funded care with a healthy dose of regulations – it cannot be denied that the ACA has been successful by many measures. In 2010, 18.2 percent of Americans under the age of 65 didn’t have health insurance. By 2023, that number had dropped to a historic-low 8 percent. In 2025 alone, 24.2 million people bought coverage through the exchanges, with 3.9 million of those being new consumers. Over 60 percent of Americans now have a favorable view of the law.
There are many things we can do to get health care costs down and make the ACA fairer across the board, the least of which is reassess the tax subsidies for individuals and the tax exemptions for employer/ employee contributions to employer-sponsored insurance and make sure they are set at the fairest, most effective levels.
There are other changes we can make that would make a huge impact: no longer require businesses of any size to offer insurance to their employees; allow small businesses to form a larger risk pool to make offering insurance more feasible; support plans that can be combined with tax-preferred health-savings accounts; address the medical-loss ratio (MLR); expand site-neutral payments; allow independent contractors to access benefits without losing their independent status; encourage portable benefit plans that can travel with workers; compensate doctors based on value-based care, not fee for service; and listen to the smart recommendations of the private sector, just to name a few.