Midterms Moment: a “Post-Covid World” Needs a Public Option

As with every election year, the 2022 midterm elections will inevitably return to the debate on the future of American healthcare. However, this will be the first “post-Covid” election cycle. If the 2020 general election was a reflection of how well the federal government responded to the pandemic and its economic consequences, the 2022 midterms will be a reflection of the varied steps to “return to normalcy” seen across the country via lifted mask mandates, vaccines & booster distribution, and milder variants of Covid-19 such as Omicron.

Given this new perspective voters will be bringing to the polls, candidates have already reignited the decades-old debate on how to reform the American healthcare system, which still lags behind nearly every other high-income nation (i.e. Japan, Canada, the UK, etc) in offering universal healthcare through a single-payer system (or something similar). More specifically, the Democratic Party’s two dominant wings - progressives and moderates - have already begun debating the fundamental question of healthcare throughout their 2022 primaries as many, including myself, hope to learn from the failures of the American response to the pandemic. As was with the 2020 Democratic primaries (and those before), I expect one idea to circulate widely within the Democratic Party and to be repeated among Republicans, the media, and the general public: Medicare-for-all.

This proposal is known by many thanks to Senator Bernie Sanders who has championed the idea for years and helped lead the momentum for it through his 2016 and 2020 presidential campaigns. Bernie Sanders’ Medicare-for-all is actually a misleading title as Medicare isn’t exactly the system he is advocating for. Rather, Sanders is advocating for a single-payer system that would 1.) eliminate deductibles, co-pays, and premiums, 2.) expand Medicare to cover everyone, 3.) expand the care that’s covered, and 4.) lower out-of-pocket spending [1].

Proponents of single-payer healthcare often bring up the inaccessibility of healthcare. Inaccessibility comes both in the form of healthcare not being guaranteed as a right and the tremendous medical debt that citizens are vulnerable to under private insurance. Under Sanders’ single-payer system, an average middle-income family making $60,000 would save around $3,800 annually [2].

Unfortunately, there is a catch in Senator Sanders’ plan: an incredibly aggressive tax package. For an estimated $32 trillion in just its first decade, more than double all currently projected federal individual and corporate income tax collections, there would need to be a complete overhaul of not only the American healthcare system but also of taxes [3]. Between a wealth tax and a more progressive income tax, his plan begins to show its cracks. These cracks are terrifying to the middle class as Sanders and his fellow progressives desperately try to explain why it’s beneficial to increase taxes on the backbone of the American economy.

Opponents also point out the elephant in the room: the huge opposition in Congress against any healthcare reform, even under the current (slim) Democratic majority. Frankly, any healthcare reform today wouldn't be considered an achievement, it would be considered a miracle.

If we really want to transform American healthcare as we know it, I believe we must stay pragmatic. Pragmatism leads us to another idea that has circulated in the Democratic Party, particularly in the 2008 and 2020 general elections: a public option. This would allow citizens to maintain access to previous private insurance, their employer’s or their personal, or be able to buy into a government-run insurance program, like Medicare. Essentially, private insurance would still exist, but people would have the freedom to choose a government plan instead.

Through a public option, the cost is more reasonable while the effect is the same, if not better. Public option proposals range from $750 billion to $1.5 trillion over a 10-year period, a stark contrast to the $32 trillion under a single-payer system [4]. This means a less aggressive tax plan is warranted, likely protecting America’s middle class from the debilitating burden of covering the country after just beginning to recover from the pandemic’s economic consequences. .

A public option also entails a bit of healthy competition between the private and public sectors. Because Medicare spends up to seven times less than private insurers on administrative costs and pays hospitals and providers less than private insurers pay for the same services, private insurers will be forced to compete with the public option’s lower costs through improved pricing, service, and, most importantly, quality [5].

It is no question that the 2022 midterm elections will be challenging and divisive. After all, midterms foreshadow a great deal - from judicial confirmations to congressional policy priorities - despite historically low voter turnout. Regardless of how candidates choose to present themselves on the question of healthcare in both the primaries and general election, the outcome of the midterm elections will be another batch of moderate median-voting-members dictating where policy proposals go next (i.e. Senator Joe Manchin). Obviously, there’s no perfect healthcare system as we must consider quality and simple access to healthcare as well as the lessons from fellow high-income nations. That said, the public option offers a reasonable, cost-effective, and liberating alternative to Senator Sanders’ idealist Medicare-for-all without sacrificing the main mission: providing healthcare to millions so that we can ensure universal coverage for all. In our new “return to normalcy,” let us consider how important quality healthcare is. While there is no perfect option, there is the public option.


  1. McFarland, D. (2020, March 16). Medicare-for-All Should Be Called Medicaid-for-All. RealClearHealth. https://www.google.com/url?q=https://www.realclearhealth.com/articles/2020/03/16/medicare_for_all_should_be_called_medicaid_for_all_110995.html&sa=D&source=docs&ust=1654039655489604&usg=AOvVaw1aLC_iOuzMgkqIREcGZ7WP

  2. Pollin, Heintz, Arno, Wicks-Lim, & Ash. (2018). Economic Analysis of Medicare for All. Political Economy Research Institute.

  3. Blahous, C. (2018). The Costs of a National Single-Payer Healthcare System. SSRN Electronic Journal. https://doi.org/10.2139/ssrn.3232864

  4. Gee, E. Rapfogel, N. 4 Myths About the Public Option. (2022, April 11). Center for American Progress. https://www.americanprogress.org/article/4-myths-public-option/

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

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