Today, I’ll focus on what our healthcare “system” actually looks like (teaser: its not one “system”).
But to start, a quick follow-up to comments from yesterday’s post.
First, let’s talk universal coverage vs. single payer insurance. The basics for universal coverage include:
Universal mandate (everyone must be insured).
Standardized benefits package set by government.
Risk equalization / income-based contributions ensure fairness.
Strict regulation prevents insurers from rejecting or risk-rating.
Nonprofit or regulated-for-profit insurers (not free commercial markets).
Single payer is simply utilizing one insurer (usually the government, as in Medicare) to achieve the tenets of universal coverage bulleted above. But it is not a requirement to achieve universal coverage.
Several European countries have universal coverage but not single payer (they utilize multiple non-profit and/or highly regulated insurers - see Switzerland, France, Germany, Netherlands, Belgium and more).
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Second, moving from our current “system” to universal coverage AND single payer such as Medicare 4 All will, if it ever happens, be exceedingly difficult. Again, this is because doing so will require legislative action and a legislative solution. In turn, this will require enough popular support AND enough political pressure on elected officials to a) force their collective hand, and b) overcome the opposing pressure from moneyed interests and their hired-gun lobbyists.
Side note: Including a public option in Obamacare would have gone a long way to getting us there, but we did not have enough juice to accomplish this because we fell short in applying a) and b) above.
Yesterday, I mentioned getting employers onboard with shifting from a partially employer-based healthcare insurance model to a standardized (single payer) model. The pushback from some commenters with reasons why this was - at best - a fraught possibility - was spot on. I NEVER said it would be easy. Just that it was worth pursuing (due to the leverage it might provide vis-a-vis existing for-profit insurers’ money/lobbying power).
Unfortunately, there is no quick fix. We need to play the long game, find the right easily understood messaging, make this a non-stop, consistent policy/political priority and apply leverage/pressure wherever it can be found to effect change.
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OK, let’s move on to the makeup of our current “system”. Ready? Here we go:
You want UK style government run healthcare where the doctors are employed by the gov’t and the hospitals are owned by the gov’t? We’ve got it. It’s called the Veterans Administration, and in 2023 roughly 9 million people received healthcare through this system.
You want Canada-style single-payer healthcare with a gov’t run insurance program? We’ve got that. It’s called Medicare/Medicaid. In 2023, roughly 36% of Americans got their health insurance through one of these programs.
You want European-style non-profit health insurers? You guessed - we’ve got that. It’s called the Blue Cross/Blue Shield insurers. Don’t have the numbers, but they are HUGE.
Finally, the kicker. No other society wants - or has - for-profit health care insurers. But - you guessed it - we do! In spades! Somewhat over half of all insured in America have private, for-profit health insurance - either through their employer or through the ACA exchanges.
To summarize, somewhat less than half of Americans already have “gov’t run” health insurance, while the remaining majority have private for-profit insurance through their employer or the ACA.
The result? Less of a system than a mish-mash of different siloed healthcare structures that results in: healthcare costs that run roughly 17-18% of our economy (way higher than every other country), a “system” that is incredibly inefficient (i.e., electronic health information systems don’t integrate with each other), and health measures (expected lifespan, child and birth mortality, among others) that lag other developed - and several less-developed - nations.
This is why we need to do away with the one USofA exceptionalism outlier: for-profit health insurance.
Let’s come up with a plan…
