The hyper-political goings on have pushed out of our national consciousness a rapidly growing societal cancer. That cancer is a health care system gone out of control. Drug prices are increased by hundreds; providers are consolidating to push out competition and jacking up prices. Private healthcare insurers are opting out of the Affordable Care Act, (ACA) leaving only one insurer per state.
Virtually everything — every procedure, every drug, every day in the hospital — costs much, much more in the United States. Providers want to be paid more than Medicare pays. Across the country, in 2014, the four largest health care insurers covered 83 percent of the market nationwide. In 2006, they covered 74 percent.
The ACA is becoming a single-payer health care system because many states are left with only one private insurer doing the paying.
Enter the public option. Health care markets will inevitably differ from region to region, but there’s no reason every one of the existing marketplaces couldn’t offer a Medicare-like plan — a plan that’s stable; a plan with predictable costs; a plan that gives patients a broad choice of providers just as Medicare does.
Thanks to the Affordable Care Act, we already have a system for subsidizing coverage for low- and middle-income Americans and a set of regulated portals for enrolling those Americans in private insurance plans that meet minimum standards. These could easily be adapted to incorporate a national public option.
Moreover, this national plan could easily build on Medicare’s existing infrastructure. Medicare is a going concern, with established systems for patient management and provider reimbursement (which actually use private insurers as intermediaries). Why come up with some fancy new system when there’s already one that people know and like?
The public option is simultaneously simple, popular, and effective. The public option would be a large plan with the bargaining power to restrain prices. And although the public option would be government-run, a big part of its appeal was that it would create more competition in the system.
A public option would be priced so it breaks even nationally, and its premium would vary with the regional variation in Medicare reimbursement rates.
Under the budget reconciliation process — which Republicans have sought to use to roll back the Medicaid expansion in the ACA — policy changes that don’t add to the deficit and that involve existing mandatory programs can be passed with a simple majority vote. A public option will reduce the deficit, and as an extension of Medicare, it shouldn’t be subject to a filibuster.
Implementing the public option and providing both the option and Medicare to negotiate prices is our only hope for stopping upward spiraling healthcare costs and for making healthcare actually affordable.
(Much of the above is based on and includes information from Vox Media, Inc. The article was written by Sally C. Pipes, President, CEO, and Thomas W. Smith Fellow in Health Care Policy at the Pacific Research Institute. Her latest book is The Way Out of Obamacare (Encounter 2016).)