Friday, Geezer asked a very good question that I didn’t have time to get to in the Frank Luntz thread. His question: Why should we be for a non-single-payer “reform” plan?
Before I get to that and ask you guys to weigh in, I want to put up some resources to look at and to think about. These are mostly comparisons of health care systems from industrial countries (and none will take much time to review):
- International comparison of health care plans from NPR. This is about a year old and very good.
- Another comparison, from Frontline, as part of their Sick Around the World program.
- From the same Frontline Program, a summary of the four basic models of health care coverage systems.
- Also from NPR — they did a major series about a year ago looking at heath care coverage systems from major industrial countries: Germany, France, Netherlands, UK, Switzerland, Taiwan, Japan. Their Health Care page includes more stories from these countries re: care and not all of them (esp. UK) are stories pointing towards a better solution.
- Another chart comparing industrial nations’ health care systems. This is a pdf.
I include all of this (and these are worthy descriptions and comparisons — no system is perfect and I remind everyone that anecdotes are not data) to broaden abit the scope of the conversation.
Part of the problem in listening to either advocates or critics of single-payer is figuring out what they are talking about. Are we talking about recreating the entire system as single payer or just the portions that will cover the uninsured or underinsured? Does that leave for profit insurance companies in place or does if make all of them move to not-for-profit status? Critics of single payer frequently invoke the UK system as the single payer that advocates want, while spinning out their scary tales of the day. Advocates almost never make clear the scope of their thinking — especially (as you can see from the resources above) single payer can take multiple forms.
The Public Option that was proposed by the House on Friday is essentially a Medicare for All program. It would be paid for by premiums from its users, with the government subsidizing premiums for poorer people and families. This part of the proposal is basically single payer, paid for by premiums. It will offer insurance to those who don’t have it now and will provide a competitive choice for the rest of us.
As to why not full single payer? Speaking for myself, it isn’t as important to get to single payer as it is to get everyone covered and get in a position to control costs. Politically, a major transformation of the entire system to single payer — with its subsequent dismantling of much of the insurance business and new rules for participation in its funding — I just don’t see as possible. Part of the problem is our politicians — few would be willing to get behind this kind of revolution in how health care is financed. Besides, most people who already have insurance are mostly concerned with costs and maintaining access to health care as our own futures look shakey. Most of us would agree that everyone needs to be covered, but those of us with insurance don’t want to be forced to give that up. That adds up to a very big political problem for those who want single payer now. As far as I’m concerned, the advocates of single payer — making the whole system single payer with insurance companies becoming not for profits — haven’t made an especially good case for that to the people who need to hear it. And that is to the people who have insurance they are OK with now. Laying down all of the chips on single payer now is a pretty certain path to not getting much of anything at all in terms of a system fix.
But if I cycle back to the info on how other countries get to universal insurance, the financing and administration model differ for all of them. Given the already successful (in terms of both customer satisfaction and in health outcomes) and certainly cheaper models of these other countries, I don’t see the choice is not between single-payer and the status quo. Many countries are using a form of the insurance model as the basis of coverage. Switzerland’s model looks alot like Massachusetts, Germany is a hybrid and the French model looks like Medicare for all. Each of these countries spends less per capita and as a percent of GDP than we do. Each of these countries ranks higher on most measures of medical outcomes than we do. Each of these counties insures everyone unlike us. We can certainly create our own model that will work.
If we were starting from health insurance scratch, we’d have alot more options I think. But a strong public option puts the survival of traditional insurance plans in their own hands. They will now have to really compete for your business and for your employers’ business. They will have to let go the games they play with their customers if they want to survive — because now you’ll be able to choose another reasonably affordable option. They’ll have to be more customer focused and work harder at cost control, because they’ll want to figure out ways to keep you even if you no longer have the same employer. It means that these companies need to completely rethink their model. It means that these companies have to learn to live in a marketplace where customer satisfaction and cost controls are going to be highly valued. Sort of the way most other businesses have to survive. So if we ever get to a single-payer for all system, it will be because the insurance companies couldn’t figure out a way to compete. Which plentyof them will find a way to do.
So what do you think? A strong public option or single payer (and define how you use the term pls) now?
Tags: Health Care