Milliman, March 2019
At its core, a single-payer system is one in which the system’s primary financing (and oftentimes the primary enrollment) comes from a single payer, which is typically the government. Reflecting the many unique ways that the federal and state governments fund and regulate American healthcare, we have identified three different single-payer scenarios, ranging from least disruptive to most disruptive compared to the status quo. (See footnote 2)
Footnote 2: The word “disruptive” was once largely pejorative, but has recently become synonymous with game-changing innovation. For the sake of our discussion, both meanings may apply.
By Don McCanne, M.D.
This Milliman white paper is not particularly helpful in defining the ideal single payer model of reform since it asks more questions than it answers. It may be useful in reviewing potential questions about single payer to prepare answers as to why a model such as that supported by Physicians for a National Health Program is the ideal which we should be pursuing. But this isn’t why this paper was chosen for today’s message.
In reaction to the newfound popularity of single payer Medicare for All, supporters of lesser measures, such as a Medicare public option, have claimed that the single payer model of Medicare for All would be too disruptive, implying that disruption is undesirable. But in the footnote quoted, Milliman (business advisers “with no agenda other than getting it right”) indicates that “disruptive,” though formerly a pejorative, “has recently become synonymous with game-changing innovation.”
Innovation is praised in the business world. In fact, those who insist that we must perpetuate the private health insurance industry state that innovation is one of the more important reasons to continue to support their industry. However, their innovations, such as restrictive provider networks, higher deductibles that impair access to care, ineffective and intrusive pay-for-performance schemes, upcoding to obtain unwarranted risk adjustment bonuses, and the like, are measures that suggest that “innovation” has become a pejorative when applied to the private health insurance industry.
Maybe in our messages we need to add two adjectives – “beneficial” and “detrimental” – as in, “It’s time for us to replace detrimental innovation with beneficial disruption.” That should be our message whether or not the rhetoric gains traction.
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