Section 1 Introduction

Section 1 Introduction

Progressive policymakers advance public option proposals under the claim of moderation, but these proposals are a Trojan Horse for moving toward single-payer, government-controlled health care. And many of them are forthright about this goal. As the authors of Chapter 1 note: “Americans should not be surprised...that a public option leads to a single-payer, government-run health care system. And they should look to other government-run health care schemes, such as in Britain or Canada, to see the results—longer wait times, fewer providers, and less access to innovative treatments.”

Prominent Democrats in the U.S. House and Senate tout the public option as a less radical approach to Medicare for All. But in reality, other than timing, there is not much difference between the two. The public option’s incremental approach to a government takeover crowd out private insurance plans by shifting the cost of medical care to health care providers and the taxpayer, coercing doctors and other providers into joining the new government plan, consolidating participation in government coverage, and ultimately limiting access to care and services.

Public option proposals lessen personal choices in both the short and long run. By effectively subsidizing the government plan, it will appear less expensive than the private competitors in the near future. Then, once private plans are squeezed out, there will be no other choice but that which the government dictates. The public option would even drive out employer-based health insurance, leaving Americans with very little agency over their own health care. As the authors state, “According to the U.S. Census, approximately 213 million Americans have private health insurance, primarily through their place of work. These public option proposals would undermine and erode private coverage in favor of government-run heath care.”

To some public option advocates, this is a feature of their proposal, not a bug. Representative Jan Schakowsky (D–IL), who has co-authored legislation to advance a public option, notes: “I know that many of you…are single payer advocates, and so am I… Those of us who are pushing for a public health insurance option, don’t disagree with the goal… This is a fight about strategy for getting there and I believe we will.”

Americans should be skeptical of public option proposals as they take away personal choice and replace it with an ill-equipped government health plan.

In Chapter 1, Heritage Foundation scholars Nina Owcharenko Schaefer and Robert E. Moffit, PhD, examine the leading public option proposals in the U.S. Congress, assess their negative impacts, and how these proposals would be used to achieve Medicare for All. They make it clear that this is one of the most pressing policy issues facing the country today—and why Americans should not be deceived by claims that a new government-run health plan would merely be another option.


Representative Jan Schakowsky, Health Care for America Rally, 2009, video, timestamp 5:25, (accessed June 26, 2020).

No Choice, No Exit: The Left’s Plans for Your Health Care