Some democratic politicians are writing off single payer as unrealistic. Granted, you don’t need single payer to have UHC. Germany, the Netherlands, Switzerland, etc. all have mutipayer systems.
But if the US was actually going to step into the 21st century and have a UHC system that is affordable, humane, well run and was based on the multi-payer system, what reforms would we need?
Off the top of my head:
Elimination of balance billing and in/out of network charges. Everything should be in network for all insurance companies.
A strong public option (open up medicare and medicaid to the public in general). Or we could have a nationwide ‘all payer’ negotiation system which would also lower reimbursement costs.
Make administration universal across all insurance providers to reduce admin costs.
Allow negotiation of all medical procedures, pharamceuticals and medical devices.
Encourage importation of medical devices from overseas to save money
Encourage going overseas for surgery and long term care to save money.
Encourage more competition domestically (increase the # of doctors and generic pharma manufacturers).
Make all prices transparent (should be redundant if we have an all payer negotiation system though).
Drastically expand subsidies to purchase insurance (via a mix of employer tax credits, personal tax credits, government subsidies, increasing the subsidies for ACA plans above 400% of FPL, maybe going up to 600% like ACA 2.0 does, etc). Underinsurance is as bad as uninsurance, it means you can’t get medical care when you need it
A back up plan that catches everyone who falls through the cracks (Medicare extra auto enrolls people under their plan for this, which is good).
I don’t know. I think, in theory, a multipayer system could work in America. But I don’t think politicians of either party have any interest in the genuine regulations necessary to make health care (either single payer or multipayer) effective as those regulations involve making powerful and rich industries do things they don’t want to do.
Point being, yeah I think UHC via a mutipayer system is entirely possible in theory in the US. In practice, probably not so much.
The rest of the states need to adopt the full Medicaid expansion.
Subsidies need to be set so that no one ever pays more than a max % (maybe around 6-8%) of their income on premiums. Today, subsidies shut off at 400% of poverty level income. That ceiling needs to be removed, and subsidies should be used for anyone who hits that 6-8% premium level.
The individual mandate needs to be reinstated, be tougher, and be enforced, so that people feel compelled to buy insurance. Maybe an auto-enrollment feature into a public option is used here for people who refuse to select a plan or get insurance through their job.
Outreach and advertising by the states & by the federal exchange, re-funding of the navigators, along with a longer enrollment period would also help.
If the above 4 items were taken into account, I think you would have UHC or very near UHC. It’s all about price points & carrot/stick type stuff. The key is #2 and #3. The current ACA has subsidies that are too weak, and the mandate is in name only at this point.
A few other things:
I would make the minimum coverage be at the level of a silver plan today. I think the bronze plan leaves too much uncovered. And the subsidies should be such that a silver plan or a gold plan**** is very affordable for the average buyer.
I think more use of HSA’s should be allowed. They are allowed now, but there are restrictions on what you can use them for. I think a well-funded HSA plus a high-deductible plan is fine. This is similar to what Singapore does, and it can work very well.
Some things like hearing aids need to be available over the counter. The ability to import drugs, etc, could help too. I think in some situations, prescriptions costs are way too much.
The problem with all the above is that Washington DC won’t do it. Republicans are dead-set against doing anything to help. And Democrats can’t force them to do anything, because they don’t have the numbers. So, I think we’ll need for a few blue states to demonstrate how to get to UHC. Once that happens, I think you’ll start to see some changes incrementally by the states. I’m hoping that a state like New Mexico, Minnesota, Massachusetts, etc, will lead the way.
I think your #9 is the most important one. #10 is also good, but I’d pair that with a strong individual mandate. I think that people have a responsibility to get health insurance so that they’re not free-riding on the system. And if they can’t afford it, then you have an auto-enroll or very strong subsidies (#9). One problem with the ACA is that the subsidies were cut off at 400% of FPL, and a lot of middle-class people were priced out of the market with no help from the government. This needs to be fixed.
I also like your #3. More standardization across the industry would help.