Perspectives from Former CMS Administrators: The Path Forward

Healthcare Costs Innovation Summit
West Health, February 21, 2018

Joseph Smith, Moderator:
At lunch we talked briefly about millennials and their absence of appetite for complexity, and looking for simpler solutions perhaps. And we talked about how health care is wildly complicated, at least the cost structure around it is wildly complicated, and it can frustrate the understanding of many people in the room. And so you were encouraging us to think about single payer systems as something that a larger cohort of the populous might be interested in. Can you expand on that?

Andy Slavitt:
Oh, I think if you asked me and probably most of us two years ago whether or not single payer would even be part of the conversation let alone a real possibility, most of us would have been pretty skeptical. And, you know, I think I’m not as skeptical any longer in large part because I think over the last year public opinion has been really influenced by being exposed to the messiness, messiness that many of the experts in this room probably see every day. But it seems to scare the crap out of the public, and it’s not just people on the left, people on the right as well. Things that are more radical and transformational, more radical than we talk about every day – I mean the stuff we’re talking about is not radical compared to some of these things – find favor in public polling. Now we can all say that they don’t understand and all those other things, but I wouldn’t be so quick to write that off. I think there is a sentiment that is not just among young people but among many that this needs to be part of the conversation, and it’s going to be part of the political dialogue, no matter what. So I think it is that moment, where that has entered the lexicon, has arrived and is arriving, and quite frankly this group probably underrepresents the part of the public that’s pushing it.

As Acting Administrator of CMS under President Obama, Andy Slavitt dutifully supported the implementation of the Affordable Care Act. Since he left office he has led the formation of United States of Care – an organization with the mission “to ensure that every single American has access to quality, affordable health care regardless of health status, social need, or income.”

He tried to make the organization non-partisan but a disproportionate number of the board members are conservative and none of them are active proponents of single payer reform. Some of us were concerned that the crucial topic of single payer might be left out of their deliberations. Thus it is reassuring to see what Slavitt’s candid views are in this Q&A before a meeting heavily attended by members of the medical-industrial complex.

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