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different public option-esque plans proposed in the House during the 2019-2020 congressional session. But a few general things can be said about how public option proposals stack up against single-payer on policy grounds. Even the most robust public options would retain some private insurance competing with the public plan.

At best, then, a public option would maintain insurance churn, meaning less stability than single-payer, and would miss out on some of the greater efficiencies of single-payer due to more complex administration. By allowing rich people to opt-out and purchase better coverage, a public option would also lack the equality inherent in having everyone on one plan.

At worst, a public option could fail to guarantee universal coverage or perhaps even barely lower uninsurance levels. Moreover, public option proposals that keep cost-sharing measures in place would offer much less financial freedom than single-payer. If the policy argument for a public option doesn’t hold much weight, what about the political argument? Again, since there are plenty of different public option proposals, with different levels of political viability, the question most worth addressing here is “Why not push for Medicare for All?” Public option advocates point to the difficulty of pushing Medicare for All through a gridlocked, nonprogressive Congress and to the possibility of public backlash due to the disruption that Medicare for All would entail.

Given obstructionist Republicans, the political viability of Medicare for All hinges on sufficient Democratic backing and control of the government. Thus, the first point to note with regard to passing the plan through Congress is that the House version of Sanders’s Medicare for All bill is currently co-sponsored by the majority of House Democrats, meaning it has more than double the co-sponsors of the most popular public option bill. The groundwork for the passage of a public option, therefore, hasn’t been laid in the same way as it has for single-payer. Electing a president (i.e. Bernie Sanders) who staunchly supports single-payer would put massive pressure on all Democrats to fall in line behind the plan.

It’s worth remembering that the current House version of Medicare for All has about double the Democratic co-sponsors the 2015-2016 congressional session version had, and that’s just after a strong progressive challenge to the establishment candidate in the 2016 presidential primary and a few new progressives winning seats in the House.

A couple more considerations strengthen the case for advocating directly for Medicare for All. First, basic negotiating logic dictates aiming high rather than low. Settling for a public option without first trying for Medicare for All is absurd by this logic. After all, advocacy for Medicare for All has already reoriented the party, making a public option the current compromise position.

Second, Medicare for All, which garners majority public support, would be an excellent central plank of a popular progressive agenda that could secure long-term Democratic control of the government.

The potential public backlash cited as a concern by public option advocates due to hiking taxes and switching people’s insurance plans seems pretty surmountable given that both the status quo and a public option would cost more and deliver less than Medicare for All and, in the long run, cause more people to lose their insurance. Plus, tax hikes could be fairly minimal if singlepayer cuts costs effectively. Furthermore, the collective buy-in generated through Medicare for All’s universality would likely make the program durably popular and difficult to cut, similar to Social Security and Medicare. during the 36 years from FDR through LBJ, before Democrats underwent a neoliberal transformation, the Democratic Party held majorities in Congress for all but four years and the presidency for all but eight. In 2016, after decades of centrist control of the party, Democrats held “fewer elected offices nationwide than at any time since the 1920s,” and promptly lost that year’s presidential election to a clown. If anything, a progressive agenda with Medicare for All at its center would boost Democrats’ public support, facilitating increased Democratic power and better prospects for such an agenda’s passage.

For years, a national health insurance program was, in a sense, the unfinished business of the New Deal. The furthest Democrats made it in the decades following Harry Truman’s failed attempt to pass national health insurance legislation was Medicare and Medicaid. Not long after the passage of these programs, the Democratic Party swung rightward, the New Deal order crumbled, and progressive economic goals were largely removed from the table.

Finally, there’s a popular progressive agenda on offer more sweeping and inclusive than the New Deal itself, with Medicare for All positioned at its heart. With Bernie Sanders, the current frontrunner for the Democratic nomination, along with a growing number of legislators unapologetically championing this agenda, its chances of passing look better and better. So the question is: Why back down when we have a real shot at winning?

The past electoral success of an economically progressive Democratic platform reinforces the idea that a powerful progressive wing could remedy insufficient near-term Democratic support for single-payer with progressive victories in future elections. Remember, Conor Smyth ‘22 studies in the College of Arts & Sciences. He can be reached at c.smyth@wustl.edu.