Brookings Institution budget expert Isabel Sawhill is concerned: “Health-care spending in the United States is on an unsustainable path.” She explains that “we face a fork in the road”:
One path leads to a privatized system. The other path leads to a public system. The path we take will have enormous consequences for our society.
Sawhill says there’s good news, though:
A sensible compromise is not only possible but may be the best outcome. In a hybrid system, everyone – whether young or old – would have access to both private insurance and a public plan.
Sawhill notes the differences, advantages, and disadvantages of public and private systems, and concludes:
Medicare for all is not a viable solution in a country that doesn’t like big government or much higher taxes..... A privatized system has some advantages; however, the benefits of choice and competition are often exaggerated.... Fortunately, we don’t have to choose one system over the other.
Sawhill argues for a grand compromise – a hybrid system:
Democrats would have to accept some form of premium support for the elderly in return for Republicans accepting a public option for the non-elderly. Over time, individuals would then vote via their enrollment decisions on which option they liked better. The government would be forced to compete with the private sector on an equal footing. And the private sector would not be able to raise premiums without limit. Best of all, seniors and working-age Americans would be in the same system, leading to more fairness and greater efficiency for the system as a whole.
Isabel Sawhill is a nationally known budget expert who focuses on domestic poverty and federal fiscal policy. She directs the Budgeting for National Priorities project at The Brookings Institution. She also served as an associate director of the Office of Management and Budget from 1993 to 1995 during the Clinton administration.
