politics
economics
Medicare for All Just Isn’t Going to Happen
Boston University, New York Times
Washington Post
0
0
Genesis
Response
Penultimate
Finale
August 29th, 2019
There's scant daylight between our views on Medicare for All, which risks a dull conversation. I'll make some attempt to change that.
First, we may slightly disagree on a public option. There's nothing you wrote that I find fault with. But there's one thing I wrote that I still think is potentially politically possible and, perhaps, you may not.
I think that under some conceivable political configuration, some state might implement something like a public option. The point would be to provide less expensive coverage that reaches more people. Obviously that entails winners (those who get insured or insured for less) and losers (those who get paid less to provide care). The potential losers are well organized and financed. That's why this is hard and not likely to happen broadly.
How would it be done, if at all? It'd probably be a Medicaid buy-in program. Or maybe it would be some other creative public-private partnership with a large health insurer to offer a more regulated, more subsidized plan. Maybe it would be constrained to a subset of the population, perhaps restricted by income or to those without affordable employer options.
I don't think any of this is farfetched. Rare, yes. Impossible? Nah. If just one state did anything akin to this in the next 20 years, I'd declare that I called this right.
Here's something more realistic, though still politically challenging, at the national level: movement on surprise billing of out-of-network charges. That patients can be hit with bills they never agreed to is egregious. (Burying some fine print in a stack of papers that one signs under duress on the way to the operating room isn't an "agreement." It's predatory.) It's not how consumerism in health care is supposed to work. It even catches people who do all the right things and when they're at their most vulnerable, a terrible outcome. Everybody knows it's wrong.
What to do? Some kind of out-of-network price regulation is the obvious answer. Once that happens, things get interesting. If there's a cap on out-of-network prices, that will influence the range of what's possible for insurer-provider negotiation of in-network prices. Either party can walk away from an in-network deal and take the regulated out-of-network one. That's backdoor price regulation. (Something just like it exists in Medicare today for Medicare Advantage plans.)
It's recognition of this that explains the intense hospital opposition to addressing surprise billing. But to support the status quo on surprise billing is not a good look for the hospital industry. It's still egregious even if the alternative is a step toward regulated prices.
I don't know of a clever way to avoid price regulation and surprise billing. If you do, I'd love to hear it. Assuming there isn't one, here's how I come down between price regulation vs. the potential of getting slammed with a massive, surprise bill: I choose regulation. Naturally, the details matter. But the status quo is highly unethical, in my view. I can't support it.
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