The February 25th healthcare summit has now concluded; everyone has an opinion on it, what it did or did not achieve, who scored points as if on an athletic scorecard, who came prepared and who did not, and so forth. Two things remain certain, however. Democrats view healthcare, or the ability to access and afford health care insurance to get healthcare, as a right. The Republicans view it philosophically as a privilege for those who can afford it, as if a product or service to be bought and sold on solely the private market. Because this is such a basic difference of viewpoint, never the twain shall meet. And this brings me to the second point. Republicans will not vote for the Democratic bill. Period. This is the end of the story. No further discussion is really needed now, except for the following.

What was glaringly noticeable were two words used repeatedly in some fashion or another: choice and competition. Regarding competition and insurance coverage, there was more than some discussion on state versus national exchanges and then the Republican idea of selling insurance across state lines. Each has its considerable drawbacks to be sure. But the alternative for competition that is the simplest and cleanest to achieve that the majority of Americans still want is…the public option for all. Why, however, was it not included in the summit, other than in passing references to it by Rep. Hoyer (D.-Md.) and Sen. Rockefeller (D.-W.V.)? Perhaps Speaker Pelosi put it the best in her concluding remarks before day’s end at the summit:

"Mr. President, I harken back to that meeting a year ago. At that time, Senator Grassley questioned you about the public option.

And you said the public option is one way to keep the insurance companies honest and to increase competition. If you have a better way, put it on the table.

Well, I bring that up because we have come such a long way…As a representative of the House of Representatives, I want you to know that we were there that day in support of a public option which would save $120 billion, keep the insurance companies honest, and increase competition.

We’ve come a long way to agreeing to a Republican idea, the exchanges because insurance companies opposed the public option. They couldn’t take the competition."

So, the reason the public option was placed on the back burner was to placate Republicans’ concerns about big government running healthcare and, instead, to adopt its idea of having exchanges. Now, we know that having a public option as an alternative way to obtain health insurance in order to lower its price tag is not big government taking over healthcare. With that, and knowing that Republicans have no interest in supporting any Democratic healthcare reform, why not reinsert the public option for all back into any legislation that arrives on President Obama’s desk for signature? No better competition will then exist for every single American mandated to buy insurance.

Recently, an acquaintance of mine, Paul Thomas from Sydney, Australia, forwarded to me an article by a noted economist and director of Access Economics down there, Chris Richardson. His piece is titled, “A healthy alternative” (February 25-March 31, 2010) ( He talks about his time living in the U.S. 17 years ago, where at the time his wife gave birth to a child and the cost for the three days his newborn and wife had to stay in the hospital—way more than it would have cost him down under. He placed this in the context of our current healthcare reform debate and the astronomical cost of health care in our country then and now. He makes one remarkable statement which resonated with me: “…health care has a lot more failure than other industries-meaning that governments can often engineer better results than unfettered markets.” That got me to thinking about the public option, and it providing the needed competition to reduce the cost of healthcare policies in the private market. In considering this with why it was out of sight at the summit taking into account Speaker Pelosi’s remarks, above, the public option needs to be resurrected—just like the mythical bird, the phoenix, that arises from its ashes.

Mr. Richardson has a very real and valid point about government, healthcare, and unfettered private markets. Maybe, just maybe, a not-for-profit, government-run entity for health insurance can provide the needed competition Main Street in America needs that the insurance industry fails to provide. Just ask how many of our seniors who have Medicare want to give it up?



Health care attorney since 1973. Author and lecturer in the US and overseas, focusing in on matters within health care law and policy. He has served as Presdient of the American College of Legal Medicine and chair for five years of the American Bar Association's Standing Committee on Medical Professional Liability. He has taught at the University of Chicago and Case Western Reserve Law Schools, as well as is a faculty member at the Rosalind Franklin School of Health Sciences, p.k.a., Chicago Medical School, in North Chicago, Illinois. He is the lead editor and and author of two books and scores of chapters and articles in the medical-legal literature.