*4.3.2 A public option*

This was included in the ACA in 2010 whereby private non-profit CO-OPs were established to sell insurance in an effort to compete with private insurers under the same rules and on a level playing field. The hope was that they could compete, reduce costs, and increase the value of health insurance. They failed to do so, however, and only 5 of the initial 23 CO-OPs survive to this day, serving just 1 percent of the 11 million people who initially obtained this coverage through the ACA's exchanges [35].

Unfortunately, the public option of one kind or another is still being talked about in some circles, despite this lesson that we should have learned—incremental steps leaving the private health insurance industry in place, which has been subsidized by government funds for many years, will never achieve universal coverage.
