25 September 2007

Back Door to Single Payer?

Maggie Mahar over at The Health Care Blog looks at Edwards and Clinton's health care plans, and she hits it out of the park. Money graf:

Quite simply, Clinton has opened the door to the single-payer model—if people want it. The beauty of her plan is that no one is forced into a government plan. Americans will wind up in a Medicare-like plan only if they choose it over a private insurer.

Clinton is not alone. Last spring John Edwards unfurled a proposal that would force private insurers to compete with a public plan that he calls “Medicare-Plus.” Today, in a web-cast sponsored by the Kaiser Family Foundation, he reiterated his goal “to give consumers a choice; they could gravitate in either direction.”

One journalist on the panel was blunt: “Is this a back-door to single payer?"

Edwards liked the question. “That’s partly right and partly wrong,” he said, with a big smile. “It’s not intended to take us to single-payer. It’s designed to let Americans decide whether or not they want single payer.”
Interesting take on it. I like the idea of giving people the option. If done right -- i.e. no structural gimmicks to favor private over public plans, or vice versa -- it will be interesting to see which way the market drifts. As a private provider of health care, I like the idea that there will be no monopsony driving down the cost of my services. -- i.e. the health plans will have to compete to maintain adequate networks. As the administrator of a small business, I like the idea that I will have more options (and hopefully more affordable options) to provide my employees with health insurance.

I've gone on record saying Hillary is not my candidate of choice -- I'm pulling for Obama. But more smart policies like this from her and I could definitely warm up to her in the general, if it should turn out that way.


  1. I have a question and a comment. First, the question: How do you (and other doctors you know) feel about FEHBP? Doctors who blog complain all the time about Medicaire reimbursement, and about private insurance claim hassles. I have never seen a doctor even comment on dealing with FEHBP. So, at present reimbursement and claim hassles with FEHBP (whatever they may be), would you be satisfied with every patient being covered by FEHBP?

    Now, the comment. My googling indicates that the US government spends an average of $3000 on everyone covered under FEHBP. If FEHBP is extended over the entire nation (as Hillary allows for), then that means $900 billion a year, roughly a third to half of the current national budget, or the total cost of the Iraq war so far every year. Either way, I will not vote for Hillary as long as she advocates such a plan without explaining how she will fund it (this is much the same reason why I didn't vote for Kerry in 2004).

  2. Rich,

    My dealings with FEHBP have been through their contracted subsidiaries -- ie if I see a patient with Blue Cross FEHBP, it's not different from seeing a regular BC patient. So no big deal, really.

    Re: Hillary's plan -- it would be funded by premiums, not by taxes. So instead of paying into you employer's plan, you could pay into the FEHBP. Maybe you like your employer's, so you keep it. Or maybe you get fired and become self-employed, in which case you buy into FEHBP.

    Yeah, $900 Billion is damned lot, but bear in mind that would not necessarily be new spending, but would just be a re-divided subset of the $1.4 Trillion we already spend on health care.


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