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    Opinion: Medicare for all: Imminent or pipe dream?


     As the nation debates the future of our healthcare system, one idea gaining attention is a “Medicare-for-all” single-payer national health insurance plan.

    While this option has gained some diverse support from the left and the right, there still hasn’t been a true national movement behind it. There have, however, been concerted and somewhat fruitful efforts in states like California and New York where the state legislatures are currently debating what a first-of-its-kind statewide single-payer healthcare program would look like.

    What a Medicare-for-all (nationalized) insurance market would mean:

    • For insurers:

    The leading thoughts here trend toward the belief that insurers will continue having similar roles and functions within the healthcare system, but that someone new will be footing the bill—namely, the government.

    While many progressive idealogues are hankering to remove insurance providers completely from the picture, this seems incredibly unlikely. The Washington Post took a really interesting but brief look at this topic. It highlighted that while Medicare’s rules about eligibility, coverage and providers are established in Washington, the running of Medicare’s services and relations with providers are carried out by insurance companies. These insurance companies  would be needed to administer a “Medicare-for-all” program, unless there was a massive surge in federal administrative staff, which would be time consuming and extremely costly.  A patchwork system that integrates insurers into a federally funded program, working closely with providers, is far more probable given the current state of affairs.

    • For consumers:

    For millions of Americans, single-payer insurance would mean the separation of health insurance from employment, allowing for increased movement of labor and a greater number of people  insured. At the national level, this  would mean universal access to healthcare for all Americans (there were 28 million uninsured Americans at the end of 2016, even post-ACA implementation), and if done at the state level, access to care for all residents of that state. 

    A program like this, of course, has to be paid for and would likely see sizeable increases in the individual tax burden to accommodate it without massive efficiency gains and changes to the way healthcare is delivered and consumed.

    • For risk adjustment:

    It may be surprising, but nothing much may happen here at all. The risk-adjustment program developed under the ACA could still hold water under a single-payer system, whether nationally or at the state level. Plans will need a working mechanism by which to be compensated for managing the care of sicker individuals—which the risk adjustment program currently does, administered by CMS. In the ACA’s commercial exchange, this allows for the transfer of funds from plans that insure healthier, less-risky populations to those that undertake administering care for the higher-risk populations .

    Even nations with completely nationalized single-payer healthcare, that do not have private insurance markets to speak of, have metrics and methods by which they adjust for health and risk in populations. For example, in cases such as the UK, funds for healthcare administered by local government bodies, and their allocations are essentially risk adjusted.

    The way risk adjustment is done, or by whom, may change depending on the future of the health care system, but the need for risk adjustment will remain constant.

    Next: A long way to go



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