Health Reform in the United States and the Non-Negotiability of the Public Option

One of the polarizing issues in the current health reform debate is whether a public option should be incorporated in the final legislation. While the program is favored by the President and most congressional Democrats, the idea is overwhelmingly opposed by Republicans. This discord has given rise to alternative proposals such as a trigger mechanism and health insurance cooperatives, both of which are being promoted as equally potent vehicles for expanding coverage to uninsured Americans. But this claim is highly debatable. To be acceptable as suitable alternatives, it would have to be shown that adopting either alternative would yield comparable result as the public option. This paper argues that such showing is not possible, that within the existing structure, the public option is the only vehicle capable of providing quality and affordable health insurance and, therefore, its place in the reform process is not negotiable