An enactment of a single payer system transitions out Veterans Health and TRICARE – they’re the first out the door

The Bipartisan ‘Single Payer’ Solution: Medicare Advantage Premium Support For All Billy Wynne MAY 11, 201710.1377/forefront.20170511.060017 ADD TO FAVORITES SHARE Editor's Note: This is the first post in an ongoing series outlining a comprehensive proposal for Medicare reform and beyond. Other posts in the series can be found here: Part 2, Part 3, and Part 4. In my last Health Affairs Blog post, I outlined a potentially bipartisan four-step plan to move past the American Health Care Act’s (AHCA’s) disastrous framework toward a more stable, less expensive health care system. For those seeking incremental, near-term solutions, I hope those recommendations provide helpful guidance. But the AHCA’s reckless drive through the US House of Representatives has taught us something about the current status of health care politics and may have opened the window to more significant, ultimately more successful, reforms. To put it mildly, the public is essentially fed up with debating how to realign the fragmented elements of our Rube Goldbergian system. Its machinations are too complex, its politics too fickle, and its rent is too damn high for the care we are getting. Where do we turn, then? More complexity? Cutting millions from coverage and shifting more costs to working families? With those options likely to be rejected, as conservative heavyweight Charles Krauthammer recently asserted, we may be heading “inexorably” toward a single-payer system. Poll after poll has in fact shown that a majority of Americans support such an approach. Most recently, an Economist/YouGov survey found that 60 percent of Americans support expanding Medicare to cover everyone, with only 23 percent opposed. If the AHCA defies odds and is enacted, this will only become exponentially truer as its impacts are felt. But, you are quick to add, there are a variety of deep-seated concerns with a single-payer approach that have kept it out of mainstream political discourse so far. That’s undoubtedly true. They include: It will necessitate massive tax increases; it will cut reimbursement for services to unsustainably low rates; it will be lower quality than the employer-sponsored coverage most Americans currently have; it will consolidate power into the hands of a small number of bureaucrats; etc., etc. My goal with this post is to demonstrate that a “unified” (punchline: It wouldn’t truly be single payer…), market-driven, federally regulated, privately delivered system need not possess any of these objectionable attributes. In fact, the parameters of such a system are all but staring us right in the face. I call it: Medicare Advantage Premium Support for All (MAPSA). While any flavor of single payer may be the last thing that comes to mind when contemplating bipartisan initiatives, just as the far left and far right share some libertarian (and other) commonalities, we may have indeed finally come full circle in this tiresome, so-far-futile debate. By combining two shots of conservative orthodoxy with one overflowing progressive one, and stirring slowly, it is not at all far-fetched to envision an endgame cocktail for our health care system that covers everyone, decreases costs, and can pass Congress. Cheers. Implementation This is another admittedly tricky element of MAPSA that warrants much further extrapolation, but, again, my goal here is only to persuade you that it is feasible. To move away from the various coverage programs currently in place, we might consider a protracted, step-wise approach. We are talking about almost 20 percent of our economy. That’s not an excuse for inaction, but it is a cause for care. Five or so years after enactment, coverage from the narrower, federally funded programs such as the Federal Employees Health Benefits Program, Veterans Health, and TRICARE, could be transitioned to the new commercially driven, federally backed, MAPSA. Three or more years later, Medicaid and individual commercial insurance market enrollees would join. Last of all would be employer-sponsored insurance, where coverage is the most stable (and privately financed). Believe me, I realize it’s easier to type this up on a computer than it is to actually pull it off. Every syllable above warrants much deeper inquiry, deconstruction, and reformulation. I said I wanted to convince you this is feasible, but I also want us to acknowledge how complicated it is. It cannot be done in one fell swoop of Bernie Sanders’ wagging finger; nor should it be casually dismissed as an economic and budgetary disaster. It doesn’t have to be either of those. Rather, I’m convinced that some thoughtful, non-ideological citizens can come together to craft a market-based, government-backed system that provides lower cost, universal coverage for consumers while protecting the livelihood and robust economic contributions of health care companies and providers. Who’s with me?