There are critics and doers. I have no faith that the government will come up with a reasonable plan on their own, not in this environment. So what can we do? We need to transition from fee-for-service to pay-for-performance. MACRA is doing that with Medicare, but the other insurance companies are not following CMS’s lead like they used to. I am not sure investor-driven private insurance companies are interested in reducing spending, because it limits their financial gains. Let’s bypass the whole single payer vs. private insurance question, and just make what we need: a government-owned, non-profit insurance company, nationally available to anyone that is not eligible for Medicare or Medicaid, working on the same reimbursement plan as MACRA.
This is an bona fide insurance company, so you have to pay premiums. But without investors to please, there is an immediate competitive advantage. This could be pushed even harder with tax deductions or even credits, not unlike the exchange.
Yes, the private insurance companies will go nuts, because it is definitely stacking the deck against them. But we have a serious crisis, and in a situation like this, we need to be extraordinarily aggressive. I am sure there are going to be some legal issues, but there is no way they are insurmountable. In fact, the more the private guys complain, the more you know you are on the right track. They had their shot.
So, we make cheaper insurance available, and we push the pay-for-performance transition. In addition, we get the side benefit of beginning to separate insurance from work, which will reduce the impact of pre-existing conditions (reducing the number of times a person changes insurance carriers reduces the incidence of a those conditions on application).
The end result will be the vast majority of people on a single payer, but there will probably still be some expensive “Cadillac” plans out there. So what. Isn’t the goal to provide affordable health care to all? Wasn’t that the goal of the Affordable Care Act? It failed because it attempted to force investor-driven for-profit private insurance companies to be something they are not: benevolent programs devoted to public service. Instead, build the company you hoped they would become, and beat them at their own game.
Now the big kicker: can you get the campaign results-driven congress to actually bite? Well, the risks to them are certainly less than polarizing bills like increasing or decreasing gun regulations. Since neither side has proposed anything similar, they can label it bipartisan, and it will pretty much be election result neutral. Since it’s an actual business that collects premiums, the tax burden will be but a blip on the radar. Hopefully there is some meager interest in doing something genuinely good for us, even if they don’t get to use it to make themselves look good and their opponents look bad. So post up the criticism and suggestions, and let’s actually DO something.