The ACP Advocate Blog
by Bob Doherty
Thursday, December 18, 2008
Is Obama's health reform plan a back door to single payer?
The health plan touted by President-elect Obama during his campaign is not a single payer, Canadian-style, national health insurance plan. Yet, there are some who worry - and others fervently hope - that it will end up being the back door entry way to a single payer system.
Let's begin by recounting all of the reasons why the Obama proposal is not a single payer plan.
It doesn't eliminate private insurance, it subsidizes it. People who don't have access to affordable coverage through their employer would receive federal subsidies to buy coverage through a "National Health Insurance Exchange." The Exchange would allow people to choose from hundreds of different private health insurance plans, just like federal employees do. No one has to switch plans though; anyone who has private insurance through an employer, and likes it, could keep it.
Obama proposes to mandate that people buy coverage for their children, opening up more business growth opportunities for the insurance industry. America's Health Insurance Plans (AHIP) has proposed to expand this to an "enforceable individual coverage mandate" for everyone, not just kids, to buy coverage.
But the Obama plan also grows government's role. Obama proposes to expand enrollment in government-run (public) plans like Medicaid and the State Children's Health Insurance Program.
And, in addition to giving subsidies to individuals to choose from hundreds of private insurers, he would give them the choice of enrolling in a public plan, similar to Medicare. Robert Pear reports in yesterday's New York Times that the public plan, according to HHS Secretary-designee Tom Daschle, would be "modeled after Medicare" and would have "tremendous clout to bargain for the lowest prices" from health care providers.
AHIP argues that because of cost-shifting, the new proposed new public program could lead to higher costs for people who already had private insurance.
The insurance industry's biggest concern is that the government plan will undercut private insurance. As a result, enrollment in the public plan would grow over time, while private insurance enrollment would contract.
This - coupled with the planned expansion of Medicaid, SCHIP, and the inevitable growth of Medicare associated with an aging population - could get the country to a single payer system, or something close to it.
It wouldn't be a single payer system created by legislative fiat, but one that comes from "competition" (fair or unfair as it may be) between private insurance and public coverage.
ACP members who favor single payer will be encouraged by this scenario. Others, who distrust giving government so much control over health care, will view it with dismay and trepidation.
What is certain is the creation of a "public plan" option will be among the most controversial elements of the Obama plan.
Today's question: Do you believe that people should have the option of choosing between a subsidized private insurance plan and a public plan like Medicare?
About the Author
Bob Doherty is Senior Vice President, American College of Physicians Government Affairs and Public Policy; Author of the ACP Advocate Blog
Email Bob Doherty: TheACPAdvocateblog@acponline.org.Follow @BobDohertyACP
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