By Cresent Hardy

Former Vice President and Democratic presidential frontrunner Joe Biden recently threw his health care policy proposal into the ring to square off against his fellow candidates’ various proposed plans. While on the surface not as radical as some of his challengers’ approaches, Biden’s plan does include a public option that will end up putting us on a slow road to a one-size-fits-all approach that simply does not work in health care, particularly for the hospitals, emergency rooms and clinics serving rural communities in Nevada and across the country. Having formerly represented a portion of the rural areas, I know first-hand how they are already suffering because of the lack of accessibility and availability. These proposals, including the "more moderate" public option that is gaining popularity, would only exacerbate the problem. 

There is no question that there are serious problems in our health care system that elected officials and policymakers should address—namely, the high cost of care. However, whether it is the public option Biden calls for or a Medicare-for-all or Medicare buy-in approach championed by some of his rivals for the Democratic presidential nomination, the fact remains that government-controlled health care will not yield greater cost savings and instead could end up threatening quality and access to care while increasing wait times, taxes and private plan premiums.

A recent piece published by Morning Consult outlines the concerns many in the health care community, particularly rural health care providers, have with this recent national Democratic trend of promoting government-run insurance systems. It’s important to realize that these plans are more than just catchy campaign slogans or taglines—they represent full upheavals of our entire health care system. And, for rural hospitals and communities, these kinds of policies will make the challenges and obstacles they face even worse.

As J.W. Cowan—a rural hospital administrator in Alabama—notes, America’s rural hospitals, ERs, and health care centers are struggling just to keep their doors open and continue serving their communities. According to Cowan, “over one-fifth of the country’s rural hospitals are at high risk of closing, putting patients and local economies in danger.” Policies that would shrink payments to these hospitals—which is exactly what Medicare for all, Medicare buy-in, and even a public option, eventually, would do—will only make it that much harder for vital facilities like these to stay open in Alabama, in Nevada and across the country.

In rural communities nationwide, hospital closures and consolidations have already shrunk access to quality care for millions of Americans. Rapidly expanding at-risk programs like Medicare and Medicaid will only serve to contribute to the financial woes facing our rural health care facilities, expediting these closures and consolidations and further threatening access to care while forcing patients to travel further, wait longer distances, and pay more in order to receive a lower quality of health care. This is not the way to expand affordable, high-quality health coverage to more Americans.

In order to address the problems in our health care system, we need to focus on building on what’s currently working and fixing—or eliminating—what isn’t. There are a number of practical policy changes that could help improve health care in America without resorting to a one-size-fits-all government insurance system—from expanding Medicaid in the states to increasing federal subsidies for low- and middle-income Americans to improving education and enrollment efforts. Most Americans would rather see our elected officials and policymakers work on improving the system we currently have over scrapping the entire thing and building a new, government-run health care insurance system.

To his credit, Biden’s health care proposal does include some more practical policy fixes that would help strengthen the ACA and expand coverage. However, the mere inclusion of the public option undermines any of the more pragmatic solutions his policy puts forward. It may not lead to government-run health care as quickly as Medicare for all would, but it would get us to the same point eventually. Ultimately, the public option is no option for rural health care here in Nevada or anywhere else. 

Our current health care system—in which more than 290 million Americans have coverage that includes essential benefits—may still be in need of some work. But instead of burning the entire system to the ground, let’s focus on putting out the fires where we can and building up what is currently working well. That is how we can best ensure that we continue to expand access to care while lowering costs for all Americans. 

 Cresent Hardy is a former Republican state legislator and former congressman.