Trade-offs in Public Health Insurance Design
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The impetus for a single-payer plan is often not only the hope of reducing costs but also the goal of expanding coverage. The same survey suggests that altruistic concern for other individuals’ access to care, encouragingly, cuts across the political aisle. Faith in whether the government or the private sector is best able to effectively provide that care is much more sharply divided.
Another potential drawback of having a single plan is that competition among plans has the potential to drive down costs and accelerate innovation. This requires true competition within the insurer market, as well as among clinicians, hospitals, and other health care facilities, which is not the case in many parts of the country. There is genuine debate to be had about the potential for the introduction of a public option to increase choice and competition to promote higher value.
The costs of a single, expansive public program point to the potential benefits of giving enrollees a choice among insurance options—free or heavily subsidized for lower-income populations—to expand coverage while allowing people to make choices that reflect their priorities and drive value. There is an example along these lines in the Medicare Advantage system already in place, and most patients enrolled in Medicaid receive their insurance through privately managed plans.
None of this is meant to say that the current system is serving the US population well now. Individuals are paying more and getting less than they should—and this is particularly true for vulnerable populations. Instead, acknowledging the societal value of expanding coverage and increasing affordability, as well as the unavoidable trade-offs involved in the design of public programs, would move the country toward implementing a fiscally sustainable, high-value public insurance safety net.
Comment by Don McCanne of PNHP : Are there really trade-offs in accepting single payer Medicare for All? What are the hidden costs, if any?
Katherine Baicker says that having a single plan can make people worse off because their needs and preferences are different. Needs and preferences may be different but that is why you need a single plan which can cover all reasonable needs and preferences. You often cannot predict a year in advance what the needs will be.
She states that the costs of having a uniform benefit has increased since Medicare’s advent in 1965, but essentially all costs have increased since then. That is what inflation does, though maybe there is also a disproportionate increase due to increased volume. But if those services are beneficial, we should keep them. We can afford them.
She also mentions the increase in tax rates, though Trump recently reduced tax rates for the wealthy. She says that it might be better to have a basic health plan for everybody coupled to increased spending on other social programs for lower-income groups. It is true that taxes should be progressive to pay for social programs, but that does not mean that benefits should be arbitrarily sorted out for health care coverage. All essential benefits should be included.
She states that premiums, co-payments, provider networks, and comprehensiveness of benefits could be made variable by providing different insurance coverage plans, but those are insurance gimmicks that should have no place in a universal public plan financed by progressive taxes.
She expresses concern that a single plan would forgo the benefits of competition, but that is fine since what we really want instead is cooperation.
But then she concludes with the statement, “None of this is meant to say that the current system is serving the US population well now.” That is correct, and that is why we should want a single, comprehensive program that covers everyone – a single payer, improved Medicare for All – a plan that would serve us all well.
Jesus: Hey, Dad? God: Yes, Son? Jesus: Western civilization followed me home. Can I keep it? God: Certainly not! And put it down this minute--you don't know where it's been! Tom Robbins in Another Roadside Attraction
January 16, 2021 at 1:38 PM #395428djean111Participant
- Total Posts: 6,571
No co-pays, etc. There is no reason anyone needs to presciently choose a fucking PLAN and then hope nothing bad happens to them, health-wise, all year. As if we all all afford the best plan for what we think will be our needs. More like whatever plan we can fucking afford and then hope for the best and hope for not the worst.
The insurance markets are fucking determined to keep their entire fucking camels, not just the noses, in the healthcare tent. Markets, competition – that did not fucking work to lower costs, FFS. And Obama fucking knew it wouldn’t.
Wow, excessive use of the word “fuck”, but it is enraging to see this fucking dialog keep popping up. Now that Bernie has folded on M4A, maybe everybody should just shut the fuck up, and stop pretending they give a flying fuck, and stop trying to tell us how fucking swell what we have (or don’t have) is now. Also – gratuitous fuck you to Warren and her beloved markets.
America is not a country, it's just a business. (Brad Pitt, Killing Them Softly)
Everything I post is just my opinion, and, honestly, I would love to be wrong.
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