Three Approaches to Health Care Reform

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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.