If the Presidential race is any guide, many Americans do not like "politicians." Weak-kneed and compromised by campaign contributions, "politicians" imperil our virtuous Republic. Or so we are told by ideologues on the Right and Left and by a distressing number of citizens whose interest in politics is but a quadrennial event.
"Compromised." A troubling word. Yet our system of government, with its divided powers, cannot function without "compromise" among competing interests and philosophies. Can we "compromise" without being "compromised"? Yes, and the resulting hybrid may even be superior to ideologically pure alternatives.
Single Payer Is Not 'Medicare For All'
Health care has been a political battleground for decades but especially in the last half-dozen years. Because the issues are complex and hit close to home, politicians, and assorted parties in interest, have little difficulty stoking voter fears. Obfuscation and distortion are all too common.
Even without intentional obfuscation and distortion, political rhetoric may blur important distinctions and conceal opportunities for compromise. Recent public opinion polls about "single payer" health care are illustrative.
A recent AP-Gfk poll found that a plurality of Americans (39 percent) support "replacing the private health insurance system with a single government-run, taxpayer-funded plan." But about 40 percent of those supporters switched to opposition if such a plan would mean an increase in their own taxes. A similar proportion of the initial supporters would abandon "single payer" if they had to give up their employer-sponsored coverage.
Bernie Sanders, famously a proponent of single payer, laments that people don't understand that wage increases would more than offset any increase in taxes to fund single payer. Since employers would not need to spend money on health benefits, he argues, they would convert the savings into wages.
Others can debate that proposition. What about the notion that "single payer" would require people giving up their private insurance?
Proponents of "single payer" sometimes label their proposal "Medicare for All," treating the two terms as though they were synonymous. Given the broad public support for Medicare, they are probably justified in thinking "Medicare for All" sells better. But "single payer" and "Medicare for All" are not synonymous.
Medicare does not require seniors to accept government-managed insurance in lieu of private coverage. One-third of Medicare beneficiaries use their "entitlement" to enroll in a private health plan under the auspices of Medicare Advantage. And that proportion has been growing rapidly.
A Robust Hybrid
While a heated debate has raged between proponents of "single payer" on the one hand and advocates for reforms based on private insurance on the other, "Medicare" has been transformed. It is an amalgam of a government-managed insurance plan and private health plans, a compromise forged by several generations of "compromising" politicians dating back to the Reagan Administration. Purists on the Left and Right may not like the compromise, but this hybrid form of Medicare works.
The government-managed plan and private health plans each offer seniors something different. The government plan offers patients a free choice of provider at a reasonable cost because it commands low prices from health care providers and has low administrative costs. Medicare Advantage plans, on the other hand, often have lower premiums and richer coverage than the government plan, saving money through limited provider networks, benefit design, and care-management programs focused on high-cost patients.
Medicare beneficiaries like this hybrid offering. Indeed, the Commonwealth Fund has found that Medicare beneficiaries are more satisfied with their health insurance coverage than adults with employer-sponsored coverage. Some seniors like their government-managed plan, while others like their private Medicare Advantage plan.
On first read, the aforementioned AP-Gfk poll seems to exemplify voter bewilderment about complex health care issues. Many Americans like single payer, it seems to say, at least until they understand what it means. Another way to look at the poll results, however, is that many voters might like a hybrid of government and private insurance.
A Path Forward?
Could it be that the way forward in health care is to extend Medicare's well-functioning hybrid system to all Americans, not just seniors?
Incorporating additional features supported by conservatives, like defined contributions based on plan bids, might further strengthen the hybrid. Defined contributions are a central element of the Obamacare exchanges and increasingly common in employer-sponsored plans. Critics on the Left will object to redefining the Medicare entitlement in this manner since it would mean that seniors choosing the government-managed plan must pay higher premiums when there are lower-cost private plans available in their market. But if defined contributions are acceptable for the taxpayers who finance Medicare, why aren't they acceptable for seniors?
In exchange for reform of the Medicare entitlement, all Americans, not just seniors, could be granted the option of enrolling in a government-managed plan (a public option), a step favored by liberals. The Right will object that this is a step toward the Federal government taking over the health care system, but rapid growth in Medicare Advantage enrollment suggests that private plans can more than hold their own in the competition.
Moreover, the government-managed plan would provide competition in markets currently dominated by a single private insurer and may even restrain the prices charged by providers to private health plans. Medicare Advantage plans usually pay providers rates that are similar to the rates paid by Medicare's government-managed plan.
Only a cock-eyed optimist would predict such a Grand Compromise in the current political environment. The issues, furthermore, are more complex than presented here. Medicare's hybrid system illustrates, however, that compromise can improve policy. Critics on the Right and Left may claim that legislators supporting the hybrid are "weak-kneed" or have been "bought by vested interests," but in reality they have made government work for the people.
from Health Affairs Blog http://ift.tt/21ZQkVh
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