Single Payer Insurance

We discuss the Affordable Care Act under Trump and look at why some states are exploring state-based healthcare solutions like single payer.

Several states are currently exploring a single payer option for health insurance (for example California, Washington, Colorado, and Nevada all made steps toward single payer in 2017).

Below we will summarize some of the events surrounding this trend and briefly state some of the pros and cons involved.

Why does the Single Payer System Seem to be Growing?

Voters expected either that ObamaCare’s problems would be fixed or that a better health care plan would be developed. Trump has made various attempts to break ObamaCare, and supported a round of controversial Republican plans, but has not yet managed to replace the ACA with anything effective.

As a result of the uncertainty and lack of a fix, some states are moving to solve their problems on a state level. See Single Payer Health Care.[1] This article will give you an overview of the subject.

Some states are using the SEC 1332. Waiver for State Innovation to move toward single payer health insurance, also known as “Medicare for all.”[2] States are also using sec. 1115 waivers of the Social Security Act.[3]

Are Any States Trying to Create a State-Based System?

Hawaii began drafting a section 1332 waiver in 2015. Washington State filed a plan which would create a single payer state-based plan in 2016. Colorado made an effort in 2016. California’s plan passed a Senate vote in 2017. Meanwhile, Washington state is working on four state-based legislative plans and a peoples’ initiative by Whole Washington.

For a discussion of state-based single payer plans in general, see State-Based ObamaCare Alternative-Sec. 1332. Waiver for State Innovation.[4] For a detailed discussion on the Washington State Bill, see Washington State House Reps Sponsor Single Payer Bill.[5]

What Happened to Trump’s Promises?

Trump had promised that he was going to repeal ObamaCare and replace it with a better program. Here are 6 Promises Trump Has Made About Health Care.[6]

  • Insurance for Everybody[7]
  • “No cuts to Medicaid” was an often-repeated Twitter promise.
  • “No one will lose health coverage.”[8]
  • “Nobody will be Worse off Financially.”[9]
  • Trump promised in a “60 Minutes” interview that he would get rid of artificial lines around the states and “allow insurance companies to sell across state lines.”

Since Trump’s support of the Republican plan, and since the obstruction (for example since defunding advertising for open enrollment and threatening not to fund cost sharing reduction payments) hopes that the above promises would become a reality have diminished. It is for reasons like this that, although many would likely support a Trump-backed national single payer (like Bernie’s Medicare-for-all), states and the people of states have been taking health care reform into their own hands with the tools allowed for by the ACA (like the 1332 waiver).

What is Single Payer or Medicare for All?

In a single payer system, a group fund replaces insurance companies. This fund would be the only payer of health insurance claims. As such, it would be able to negotiate prices for medications and fees for health care services.

Tax payments made by everyone support single payer systems such as the V.A., Medicare, and Medicaid. For a more detailed look at one version of the plan see Bernie Sanders Single Payer Overview.[10]

What are the Positive Aspects of Single Payer systems?

In many respects, single payer systems may be fairer than our current model of for-profit health care. Trump has said publicly that Australia, which has a single payer system, has better health care than America does. ObamaCare and Australia’s HealthCare Systems Compared.[11]

Most advanced industrial countries have single payer healthcare. It saves most of them money. Americans tend to believe that the U.S. has a free-market health care system. Not only is this myth, but we also spend more per-capita on healthcare than most countries.[12]

What are the Negatives of Single Payer Systems?

We have vast amounts of wealth generated by our medical industry. Health professionals, hospitals of various sorts including free-standing emergency rooms, clinics big pharmaceutical companies, and others depend on our fragmented care delivery system for funding. It is no surprise that Americans pay more for pharmaceuticals than people in any other developed country. Further, the entire health insurance industry depends on our care delivery system for profits.

All of our single payer systems, the V.A., Medicare, and Medicaid have made it unprofitable for doctors to remain in the system. Reimbursements are limited and lag behind private payers. The amounts permitted to be spent on medications tests, and procedures are also restricted. Many medical professionals who formerly participated in our single payer systems now either participate from a sense of public service or have stopped accepting that whole class of patients. See Disparity in Pay Divides Doctors for a discussion of this results of the pay gap.[13]

We will need to find a way of keeping this vast section of the health care industry profitable in any system we develop. We cannot expect participation in a single payer system to continue to rely on providers’ charitable impulses.

Citations

  1. Single Payer Health Care
  2. SEC 1332. Waiver for State Innovation
  3. About Section 1115 Demonstrations
  4. State-Based ObamaCare Alternative-Sec. 1332. Waiver for State Innovation.
  5. Washington State House Reps Sponsor Single Payer Bill
  6. 6 Promises Trump Has Made About Health Care
  7. Trump Vows ‘Insurance for Everybody’
  8. Trump Advisor Conway says no one will lose health coverage
  9. Price on ObamaCare Replacement
  10. Bernie Sanders Single Payer Overview
  11. ObamaCare and Australia’s HealthCare Systems Compared
  12. Conservative Think Tank: 10 Countries With Universal Heal Care Have Freer Economies and the U.S.
  13. Disparity in Pay Divides Doctors

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