By Len Rodberg, PhD
Public Single Payer Approach: Expanded and Improved Medicare for All (HR676)
John Conyers: “Ensure that every American; regardless of income, employment status, or race, has access to the highest quality and affordable health care services possible.”
* Automatic enrollment in unified public plan
* Free choice of doctor and hospital
* Doctors and hospitals remain independent, negotiate fees, budgets with public agency
* Public agency processes and pays bills
* Financed through progressive taxes
* Cost control through budgeting, capital planning, emphasis on primarycare
Private Republican Party Approach: Individual Responsibility (“You’re On Your Own”)
John McCain: “The key to health care reform is to restore control to the patients themselves.”
* Shrink employer-based insurance by eliminating the employers’ tax deduction
* Use tax credits to partially subsidize individuals, encourage purchase of insurance
* Make “consumers” more cost-conscious through taxes, co-pays, and deductibles
* Eliminate “costly” state “mandates” (consumer protections)
* Lower costs through market competition
Public-private mix Democratic Party Approach: Private Insurance, Public Option & Mandates
Barack Obama: “Quality, affordable, and portable coverage for all”
* The problem: Too many uninsured
* The solution: Require everyone to have insurance
* Public Medicare-like option
* Guaranteed issue, community rating
* Sliding-scale subsidies for low-income individuals and families
* Employers must contribute but may choose not to offer insurance
* Continued reliance on private insurance, no regulation of premiums or reimbursement practices
* “Keep what you have”
* Cost control through computerization, disease management, insurance competition
What’s Wrong with Approaches that Include Private Insurance?
* Will not improve insurance coverage for most people.
* Will not make affordable insurance available.
* Will not address the problem of underinsurance.
* Will not contain the continuing growth in the cost of health care and premiums.
* Require complex income-based subsidies.
* Will not pass, since they don’t benefit enough people to build popular support.