From here to single payer, a path forward

May 15, 2019 11:10 pm

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High health insurance costs and high numbers of uninsured have generated political pressure to adopt a single-payer health care system.

The challenge for single-payer advocates is to convince the general population that a conversion to a single-payer system will not bankrupt the government nor deprive them of quality healthcare.

The solution is to implement an intermediate step using the Medicare program to provide an open access insurance product that has high quality, higher affordability and lets people convert voluntarily. Some call this the public option.

This approach is a viable path forward to a single-payer system that would use market-based forces to convert individuals and businesses currently enrolled in private health insurance and result in significant cost savings and fewer uninsured.

Single-payer health care is a hot issue among Democratic presidential candidates. Most of these candidates support a single-payer system while a few support more moderate proposals.

Studies show that a single-payer approach, like “Medicare for All,” is the most efficient way to deliver health insurance.

Surveys show that most Americans want single-payer healthcare except when they are also asked if they favor elimination of private health insurance in the process. Then, single payer popularity decreases. Outright opponents to single payer raise concerns about “socialized medicine” and theorize unaffordable government costs.

As an alternative to going directly to a single-payer system, we could expand Medicare eligibility to all individuals and businesses, where enrollees under 65 would be charged an insurance premium based on income and age.

This Medicare option would compete with private insurance on Obamacare exchanges and provide a lower cost, higher value health insurance choice.

Enrollments would increase compared to Obamacare as more people would be able to afford this coverage. Such an approach could offer — as a political selling point — federal revenue neutrality relative to current Obamacare and Medicare funding while still offering cost savings to those signing up.

The other attractive feature of this approach is that it would not force people to give up their private insurance, rather it would offer a competitive alternative to private insurance. Because of its lower cost and high quality, the Medicare option could completely displace private insurance in the individual and small-business marketplace.

Furthermore, larger businesses would, over time, migrate their insurance plans to the Medicare option after the Medicare option proves itself in the marketplace. Private insurance companies would either need to come up with a viable approach that competes with or works with Medicare, like a transformed version of Medicare Advantage policies, or go out of business.

Single payer can be achieved using the Medicare option as a first step. The upcoming 2020 presidential race will provide an excellent forum for this debate.

Tom Hicks is a U.S. Naval Academy graduate, former nuclear submarine officer, engineering consultant, former Democratic congressional candidate, father and, husband. He lives in Montpelier. @tomhicksva1

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