Understanding the differences between Universal Healthcare, “Medicare for All” and Public options.

Alan Myron
6 min readSep 27, 2019


Confused about Medicare For All talk? Don’t be, the legislation is clear.

In a previous article I have described the reasons as to why single payer universal health insurance is the most cost effective way to provide healthcare to all Americans. In another article I discuss the role of private insurance under the implementation of the House and Senate plans to implement “Medicare for All”.

Unfortunately we have stopped applying critical thinking and dive in deep research before believing something. We prefer to make up our own mind, go to the marketplace of ideas, and pick the one that better aligns with our current preconception.

Truth doesn’t work that way. Truth is independent of beliefs. This is important given the outrage and polarization in the implementations for universal healthcare. Why people are passionate about this subject? Because it is literally a matter of life and death. But we also need to be objective, and look at the facts. To clearly define, what we want, what is possible to get, and how to achieve it.

First a few definitions.

Universal Single Payer Healthcare: An idea in which every single doctor and treatment is covered under a government sponsored program, leaving no room for private insurance because it is prohibited by law, ALL services are covered, and all healthcare providers are forced to accept it.

Medicare for All: A program in which every American contributes a portion of their income and in exchange a large number of life saving and life prolonging treatments are made available without additional cost.

Medicare Choice/Single Payer Plus: Terms coined by Representative Tulsi Gabbard to expand over the single payer system. Recognizing that there are additional healthcare services that are not covered under existing Medicare for All bills.

Public Option: A term defining the co-existence of publicly funded healthcare AND private insurance, both serving THE SAME needs of the patients, with the ability to select one OR the other.

Current system: Healthcare insurance is private and only elderly or the poor have access to programs to partial healthcare coverage.

Alternatives of healthcare insurance

Let us start from the bottom of the table.

Current system

In our current system, nobody is forced to participate, but that also means that if you don’t participate you are not covered unless you are old or very poor. And even in those situations given that not all services are covered there is still a cost that needs to be covered by your own funds. Our current system is inefficient because the healthcare insurance companies are for profit companies, and the only way to increase their profits is by either raising prices or limiting care and payouts. We clearly need something better than this.

Public option

Why is a public option popular with the insurance companies? Assuming they are forced to accept some form of government interference, a public option is actually a way to privatize profits and socialize risks.


Because a public option will need to accept ANY American, independent of health condition. Under a public option, private companies can create insurance plans targeted to healthy and young populations. They WOULD appear to be more cost effective because they will ONLY apply during the low-cost lifetime of the patient. Once a patient becomes chronically ill, Insurance companies can raise premiums so that it becomes impossible to afford them, and then people will move to the public option.

Because the public option will be biased towards less healthy people, its costs will be higher, and it will give the appearance that the public option is less cost-effective than the private option. This in turn, can be used as evidence that the government is ill suited to provide healthcare, thus reducing the widespread support of an universal healthcare coverage.

People will think “If not even the public option worked! How can we expect a universal single payer system to work!” This is critical. A public option is the Trojan horse to derail universal single payer coverage.

Medicare for All (Senate version)

Every American pays into the system, and every American receives very generous and life-saving treatments. Under this program, no American will die for the lack of coverage or go bankrupt (assuming the patient uses the Medicare network).

Look at the legislation. Because Healthcare providers need to opt in the program, only those healthcare providers who opt in the program will be covered under Medicare for all.

This means that there is a real possibility that your Doctor may choose not to participate, and therefore it leaves you with two options: Pay the Doctor directly or buy a private insurance that covers your doctor.

At this point people are going to say: But hey! there is a non-duplicative care provision! You cannot get private insurance!

You will be wrong, and this is the biggest misconception. The legislation is very clear, to something be considered covered the service AND the provider need to be covered under Medicare, if the service OR the provider is not covered under Medicare, then the provision of private contracts kicks in, opening the door for private insurance AND cash payments to healthcare providers. For more details on the differences between the House and Senate bill, please refer to a previous article.

As stated in that article, the Senate version allows Healthcare providers to select the procedures they want to cover under Medicare for All. Which can cause a ramification in the quality of service that a healthcare provider will give to a patient.

Can it create a tiered service among Medicare healthcare providers? Yes
Does it make the program worthless? No

Medicare for All (House version)

Similar to the Senate version, however; in the House version, healthcare providers cannot pick and choose which services they will cover under Medicare, it means that if they provide one service, they must accept Medicare payment, and are prevented of taking extra payments. In that sense, it is impossible for this program to encourage a tiered service by healthcare professionals taking Medicare.

Can it create a tiered service among Medicare healthcare providers? No
Does it make the program worthless? No

Medicare Choice/Single Payer Plus (Tulsi Gabbard’s interpretation of the House Medicare for All bill)

Tulsi has been very clear that Medicare for All will provide a base level (like the House and Senate legislation do), and people are free to buy private insurance (like the House and Senate legislation allow for).

The “choice” is not about choosing between public and private insurance, it is about choosing to get or not get private insurance. Public insurance is a given, you are covered, you pay into it, just like people pay property taxes and school taxes and can choose to send their kids to private school. You always have the option to take your children to public school, but you may want something different, well, you pay for it, but this does not allow you to not pay into the public system.

Recently Tulsi renamed her plan “Single Payer Plus” which reflects better her philosophy about providing healthcare to all Americans. The details haven’t changed, only the name.

Tulsi healthcare position, is the most consistent with the bill she voted for in the House. And she will soon release the details of her own expanded plan.

Universal Single Payer Healthcare

This is the dream in which every American pays into the system, every possible healthcare service is provided free of charge at the point of service, and ALL healthcare providers are FORCED to take only Medicare at the reimbursement rates the government decides.

This is extremely dangerous. It will severely cripple our ability to convince people to go into the medical field, it is a major violation of the rights of healthcare professionals, even when the end result would be the best for the rest of the population.

But practically, without healthcare professionals, there is no healthcare.

And this is why the Medicare Bills (both House and Senate) are the best realistic, and practical implementations of a system that approaches this ideal.

I am personally really disappointed of many politicians and news personalities who claim that the Medicare legislation in the Senate or the House is an implementation of this Universal Single Payer Healthcare system that will completely make Private insurance redundant and illegal.

My only plea, is to read the legislation by yourself, you can use this article as a starting point, and make sure that what your politician or favorite news person is telling you is consistent with the legislation they are claiming to support.

Both the Senate and House bills are good bills that will help us lower costs, make our economy more productive and reduce the pain and suffering of millions of Americans. They are both good bills, but please, let us represent them accurately.



Alan Myron

I believe in the goodness of mankind even when the evidence proves the contrary. Engineer by day, Poet in my dreams, and 100% AMERICAN every waking moment.