Hillarycare: The Slow-Walk to Single-Payer
If you have maintained health insurance over the past few years, you, like millions of other Americans, have been quietly sustaining annual increases in out-of-pocket costs stemming from rising premiums and deductibles under the Affordable Care Act (ACA). These cost increases, combined with the announcement that UnitedHealthcare and Humana will exit the majority of Marketplace Exchanges in 2017, beg the question, what will the next President of the United States do to fix our healthcare system?
These issues are critically important when looking at Hillary Clinton’s evolving policy solutions, which largely center on expanding more of our publicly funded healthcare programs. At a recent campaign event, Mrs. Clinton suggested Americans between the ages of 50 and 64 should be able to voluntarily ‘buy in’ to Medicare, a proposal one step short of Bernie Sanders “Medicare for All”, a plan estimated to account for an additional$14 trillion dollars to our national debt over the next ten years.
Supporters of expanding the Medicare program say it will lower the cost of health insurance for young, healthy people shopping on the Marketplace Exchanges. Those who oppose the expansion argue it will give federal officials authority over healthcare decisions for a massive pool of people more likely to be sick, while also shifting greater cost burden to the American taxpayer.
Another Hillary proposal is to create a government-sponsored health insurance policy commonly referred to as the ‘public option’. The public option is a taxpayer-subsidized alternative to private insurance available to people buying health coverage on the open market. The idea is to offer inexpensive health insurance that will compete with private plans, with the dual role of keeping insurance companies ‘honest’ by offering government-sponsored ‘competition’.
Originating from health policy experts at the University of California, the public option was a compromise between a single-payer system and managed competition among private plans. It was later expanded as a national health policy reform concept in a Robert Wood Johnson Foundation’s Covering America Series, “Getting to a Single Payer System Using Market Forces: The CHOICE Program” released in 2003.
For those in favor of implementing a single-payer healthcare system in the U.S., the timing for re-introducing the public option could not be better. If people have a choice between purchasing either a low cost insurance policy or a high cost insurance policy–that provides essentially the same or similar benefits–many will choose the low cost policy in order to save money. This is especially true after a few years of Americans taking on much of the cost burden brought on by provisions of the Affordable Care Act.
For the private sector, offering a public option on the Obamacare marketplace will most certainly challenge private insurer’s budget predictability and enrollment projections for their products, at least in the short term. On the provider side, if history is any guide, payment rates for the industry will be set by a federal fee schedule for treatment options, which often pay well below market price.
If both the Medicare expansion and public option policies are introduced under the next President, the private insurance market share will shrink to accommodate only who can comfortably afford those plans, creating a two-tiered healthcare system between the haves and have-nots.
Over time, if a majority of Americans transition to programs such as Medicare, Medicaid or the public option, we as a country will be on track to having the federal government dominating healthcare delivery in an unprecedented way, putting the U.S. on its way to becoming a single-payer healthcare system as envisioned by the progressive movement.
The implementation of Obamacare has caused private health insurance to increase premiums and deductibles to meet both shifting market demand and regulatory compliance, largely passing on these added costs to the American people. Continuing to expand the program will most certainly force greater government control into our healthcare system. With this we will not only see a serious reduction in private sector insurer options, but also the introduction of longer wait times, wait lists, and limits on pharmaceutical innovation as evidenced in closed, government-run healthcare systems around the globe.