Can Health Insurance be Both Universal and Voluntary?

A tracking poll from the Kaiser Family Foundation finds that 56 percent of Americans favor a fully government-run Medicare for All insurance plan, but that an even larger 68 percent favor a mixed public-private approach with a public option. The most common reason given by those who support a public option but oppose Medicare for All is a desire for choice. They do not oppose the idea of public health insurance, but they do not want to be forced onto it.

Given those public attitudes, it is not surprising that many Democratic presidential aspirants have shied away from Medicare for All in favor of plans based on a public option. Pete Buttigieg emphasizes the element of choice in the very name of his plan, which he calls Medicare for All Who Want It. Other candidates backing one or another form of public option include Joe Biden, Amy Klobuchar, and Michael Bloomberg.

There is a dilemma at the heart of the public option approach, however. Is it possible to offer choice in health care coverage and still achieve universal coverage, another cherished goal of reformers? Or does the attempt to achieve universality inevitably require making enrollment compulsory?

In my view, it should be possible to preserve meaningful choice in health care while ensuring universal access to coverage. But doing so will require…