Healthcare in America has a turbulent history; it has created champions and failures from politicians from every party. Current events aiming to repeal or amend the Affordable Healthcare Act have resulted in widespread protesting, illuminating how essential and arduous a task it is to create a viable and beneficial healthcare policy. As Graham Walker MD (2004) demonstrated in his animation, a single payer system is like prom. You buy your ticket upfront, and that covers everything. It provides entry; it pays for the food, pays for the DJ. Which allows people not to have to worry about how much things will cost; there are no additional bills. The Prom Committee takes all the money upfront and handles everything for you. The DJ and caterers do not have to charge each person, which contributes to more time to serve the prom attendants better. Having better food and music means more satisfaction from the patron, and not having to present each guest individually with a bill means less concentration on paperwork. The single-payer system would be similar. The government would be the prom committee. They would take the money upfront from Americans and use those funds to pay for health care across the country.
A new health care tax would finance the budget for single-payer health insurance. The hospitals would receive money to cover all the operating expenses. Physicians would be reimbursed by a predetermined method. Using this approach would eliminate the billing process. By cutting administrative costs, there would be more money going toward curing patients. While implementing the new health care tax would cause taxes to increase for all Americans, it will still be less than the premiums and out of pocket medical costs that we face today. Those that are uninsured will not wait until they are so sick that they must go to the emergency department, which takes care away from those that are genuinely in need of emergency care. Instead, they will go to their doctor and receive both preventative and ambulatory care. Uninsured people going to the emergency department increases premium costs and uses scarce resources for only short-term benefits. In turn, business would be able to offer higher paying wages to their employees. There are many steps and obstacles to overcome to propose even such a change in the healthcare system. Many legislative hearings and discussions will happen. Even if the legislation passes the bill, the governor of the state can still veto it. We only fail when we quit trying but having worked in the healthcare field in a hospital setting it seems evident that the system would affect affordability and accessibility for all.
Pass the Law
The first step in change is passing the health care tax law. California legislature passed bills in 2006 and 2008 to create this system but was vetoed by Governor Arnold Schwarzenegger (Rojas, 2008). With such a law, many details delegated to officials such as making sure the health care tax law would be consistent with current laws and regulations. Each state would receive funding only permitted under the law as well as integrating federally administered health benefits to regain some of the general expenses that would usually be spent on federal programs. The federal government will set prices for services and procedures and establish the annual budget for health care expenditures.
Affordable Care Act Waiver
Next, a state must obtain an exemption from the Affordable Care Act. The Affordable Care Act requires that those that do not have health coverage through an employer to obtain it through individual policies or will pay a fine. Expansion of Medicaid has helped cover more Americans ("Explaining Health Care Reform," 2012). Because of the statutes in the ACA, states would encounter roadblocks to establish a universal care system. However, a waiver can be obtained to negate all requirements. For the exemption to be approved, the state would have to demonstrate that the proposed alternative would provide coverage and be as affordable as the Affordable Care Act, would cover the same amount of people as under the act, and add no additional cost to the federal government. The government would be required to provide the same amount of funds as they would if the state were acting under the Affordable Care Act (The Patient Protection and Affordable Care Act, 2010).
Medicare Integration
Next, the state would then have to coordinate with Medicare. One-fifth of all health care expenditures are covered by Medicare (Jacobson, 2010). Medicare can be helpful in a universal payment system, but may also create some obstacles. Medicare is like a global payment system to those that are eligible and is publicly funded. Medicare has proven it is better at controlling costs than private insurance companies (Archer, 2011). Medicare has negotiated lower prices with physicians and has achieved lower administrative cost. Medicare would be another primary payer and would diminish the possibility of a single-payer system. Medicare could be persuaded to grant funds, that would be exchanged for promised coverage and services, which would be like the terms set in the Affordable Care Act Waiver (Social Security Act 1814(b) 3) and 1833(a) (2)). Unfortunately, now, Medicare does not have the authority to adhere to such a request. Therefore, to have a universal system, it must cooperate and collaborate with Medicare.
One option to remedy this situation allows the state to operate the single-payer system next to Medicare. The patient would have to transition to Medicare when they reach the age of 65. The other option is to allow Medicare pricing to be integrated into the new system. The physicians would bill the state, and the state would have to settle the matter with Medicare. Uniform prices would make the billing process simpler. With this option, if the patient chose to enroll in the state Medicare Advantage program, it would be an easier transition when they reached 65.
A second option would be to model and eventually morph Medicare into one full single-payer system. The healthcare tax would still apply to all citizens who would, in turn, use the government health care system to pay for their health care. The system would work the same way as Medicare by covering cost and negotiating prices. Instead of having the citizen transition into Medicare at 65, they could just continue with the government program, thus eventually retiring Medicare and having one single system.
Medicaid
Next is the obstacle to integrating Medicaid and State Children's Health Insurance Program (SCHIP) with the national program. Medicaid is necessary to expand access to health care under the Affordable Care Act. Federal money is administered by the state to cover individuals that are eligible. The state would reimburse providers at the same rate as Medicaid does; this would mean lower rates for all (Department of Health and Human Services, 2012). A way to incorporate is to have patients use electronic cards when receiving service. The information from the cards would tell which program the patient is enrolled in and send it to the government. The physician would not need to know which program the patient is enrolled. The Medicaid program is flexible and can be adapted to meet the nation's needs moving toward a single-payer system. Medicaid like Medicare can be eventually retired but morphing it into the single-payer system.
Conclusion
Currently, healthcare services are billed to a private insurance company, federal programs like Medicaid and Medicare, or to the patient, or a combination. A single-payer system would shift the costs to the national government. It is likely that using this system will reduce the overall cost of the current system, even though it would be covering more people.
Making a single-payer system would require overcoming some challenging obstacles. The federal law appears to be flexible enough to overcome these barriers. Alignments with federal programs would have to be made. Information technology would have to be adapted to process billing. Achieving a universal system would have enormous health benefits while presenting excellent economic benefits that outweigh the cost of investment (Woolhandler, Campbell, " Himmelstein, 2003). This alone would assist in costs for access to care. Using this system will create more efficient care by offering access to preventative care, tests, and procedures that were not available for some before.
References
Archer, D. (2011, September). Medicare is More Efficient Than Private Insurance. Health Affairs. Retrieved from http://healthaffairs.org/blog/2011/09/20/medicare-is-more-efficient-than-private-insurance/
Compilation of the Social Security Laws. Conditions of and limitations of Payment for Services. Social Security Act 1814(b)3) and 1833(a)(2).
Department of Health and Human Services. (2012, February). Rules and Regulation. Federal Register, 77(38), 11677-11700. Retrieved from https://www.gpo.gov/fdsys/pkg/FR-2012-02-27/html/2012-4354.htm
Explaining Health Care Reform. (2012, July). Kaiser Family. Retrieved from http://bit.ly/17liO1X.
Jacobson, L. (2010, February). Biden overstates the role of Medicare, Medicaid in U.S. health care spending. Politifact. Retrieved from http://www.politifact.com/truth-o-meter/statements/2010/feb/16/joe-biden/biden-overstates-role-medicare-medicaid-us-health-/
Lincoln, T. (2013). A Road Map to 'Single-Payer.' Retrieved from http://www.citzen.org
Rojas, A. (2008, fall). Gov. Schwarzenegger again vetoes the single-payer bill. Physicians for a national health program. Retrieved from http://www.pnhp.org/news/2008/october/gov_schwarzenegger_.php
The Patient Protection and Affordable Care Act, Public Law 111-148, Section 1332 (March 23, 2010), Retrieved from http://1.usa.gov/gaf3kD
Walker, G. (2004). Single-Payer. Retrieved from http://www.grahamazon.com/sp/whatissinglepayer.php
Woolhandler, S., Campbell, T., " Himmelstein, D. (2003, August). Costs of Health Care Administration in the United States and Canada. The New England Journal of Medicine, 349(8), 768-775. Retrieved from http://www.nejm.org
