Universal healthcare is top of mind for healthcare stakeholders. Here’s four things you need to know about it right now.
While the uncertainty swirling around healthcare continues talk of the single-payer or "Medicare for All" model is on the radar screens of industry watchers.
“The idea is that the government would be the ‘single’ payer,” says Julius W. Hobson, Jr., senior policy advisor at Polsinelli law firm in Washington, D.C. “Providers and healthcare executives have generally opposed this concept out of fear the government would set artificially low prices.”
With that in mind, here are four things industry insiders believe healthcare executives need to know about single-payer healthcare:
1. The single-payer concept has gained support in the U.S. since the late 1990s.
“Opponents of single payer have argued the Affordable Care Act [ACA] was the stalking horse for single payer,” says Hobson. “In fact, the Democratically-controlled Congress clearly opposed the concept. What we see now, politically, is a Republican majority attempting to roll back the ACA. This party has been pushed farther right by activists who don’t see healthcare as a right. The Democratic party is now facing the same thing from the left as activists are attempting to make the issue a litmus test for potential presidential candidates.The fact that potential Democratic presidential candidates are cosponsors of [Bernie] Sanders’ “Medicare for All” legislation is evidence of this leftward movement."
The result of these actions is to push the two parties farther apart and making any potential ACA corrections that much more difficult to achieve, says Hobson
"For decades in the U.S. there has been a call for universal coverage, for federal assurance that all persons in the nation receive guaranteed access to health services regardless of age, gender, where they live, medical history, employment status or other measures," says Jay Wolfson, DrPH, JD, distinguished service professor, Public Health, Medicine and Pharmacy, and senior associate dean, Morsani College of Medicine, University of South Florida Health.
“Most Americans think this may make sense, and it has generally been the case, by law, in all emergency rooms across the U.S.,” Wolfson says. “Universal coverage is not an inconceivable goal, but it would require structural, financial and political healthcare system reform that would dwarf the policies of the ACA.”
2. Single payer and universal healthcare are not always the same.
“Whether one argues for or against universal coverage … it is not single-payer,” says Wolfson. “Let’s be clear. It is code for ‘universal coverage,’ and as such, it is an abused and misleading term. The ‘payer’ is somebody-taxpayers, employers, individuals-we will have to pay to make universal coverage happen, and that won’t be cheap, though it may be what Americans really want.”
Executives should help educate those who misuse the term or do not understand what ‘single-payer’ means and what would have to be done to achieve universal coverage, says Wolfson, who is also associate vice president, USF Health.
“If by ‘single-payer,’ pundits mean ‘single administrator’-getting rid of all the insurance, managed care and third-party financial services companies that have for decades literally run the banking and payment decisions via contract for public and private funders-that would mean having the federal government, or some single entity, become the exclusive administrator of financial and health benefit decisions. The federal government would have to start up a new business or buy a very large, existing one,” Wolfson says.
"Opponents argue that government-based healthcare is less efficient that privately run insurance companies," says Joseph M. Mack, MPA, of Joseph Mack & Associates, a managed care and value-based consultant. "Proponents argue that privately run insurance companies continue to make high profits by selectively including healthier and excluding sicker patients."
Discussion about healthcare as a right, how to provide coverage to all citizens, how to finance various approaches, and how to ensure that the most qualitative, cost-effective healthcare is available and delivered to Americans is a healthy debate, says Mack.
"Healthcare executives should continue to focus on increasing the health status and outcomes of the populations they service, by improving access points and time to see providers, implementing and improving upon clinical protocols and standards to ensure that the best medicine is delivered at the right time, by the right individuals, in the right settings, and in the most cost-effective ways," he says. "Proactively addressing these issues well positions providers and payors to succeed regardless of single-payer, Medicare for All, or free-market health insurance."
Next: The third and fourth things you need to know
3. Single-payer healthcare might be comparable to Medicare Advantage.
“When CMS instituted the Star Ratings program linking health plan quality performance and member satisfaction to significant bonuses and rebates, they designed a system to achieve true value-based performance,” says Tom Wicka, CEO and cofounder of NovuHealth, a healthcare consumer engagement company. “By linking performance and satisfaction, CMS created a system that allows health plans to incent members to engage in their health and close care gaps.”
This strategy of motivating members to engage in their personal health and rewarding plans for performance is the same approach any single-payer system would also need to embrace, says Wicka.
“More broadly, any population covered under a single-payer system will need to take more personal health responsibility to lower long-term medical costs if health plans and providers are to be paid based on value delivered,” he says.
4. Single payer is a financing mechanism; it is not a silver bullet answer for an improved healthcare delivery mechanism.
“Policy leaders often reference better healthcare outcomes and lower healthcare per capita expenditures in single-payer and universal healthcare coverage democracies when compared to U.S. results and measures,” says Patrick D. Pilch, National Healthcare Advisory Leader, BDO Center for Healthcare Excellence & Innovation.
“While the comparisons do have some validity, current U.S. healthcare delivery models need to be realigned and clinical outcome measurement systems need to be imposed beyond existing measures that are associated with value-based payment models,” Pilch says.
Without coordination of verifiable outcome measures, there can be no certain assurance of improved healthcare outcomes, he says.