The single payer proposals I have read deal mainly with the consumer side regarding access to care and reduced patient costs. What seems to be missing is recognition that medical groups and hospital have built their budgets around the existing health insurance plan reimbursement rates. There is no mechanism in the single payer proposals to limit the costs such as the cost of labor (nurses) which is a significant financial element for hospitals. Until we get a handle on the cost of health care, health insurance rates will continue to rise and a viable single payer proposal, where you have more than one or two hospitals participating, will only be a dream.
I find it amusing that the strategy to kill off government funded and managed health insurance for people may be the very illustration and demonstration of how single payer can work. The added benefit is a nod to the fact that, if included, volunteer work or family care work is treated as equally valuable as a wage earning job for eligibility for Medicaid. This is an acknowledgement that people volunteering in our communities plays an important role in the maintenance of the community fabric.
First, let me clear that I support the concept of a single payer plan for health insurance coverage. It has worked relatively well for Medicare beneficiaries and a similar concept could be mirrored nationwide. However, proponents of Senate Bill 562, the single payer legislation, are long on promises and short on details. If we have learned anything from the launch of Covered California to serve as the market place for ACA health insurance it is that the best laid plans are far harder to execute than anyone could imagine.
I was dumbstruck when the mother of one family whose household income is $134,000 per year was quizzing me on they could avoid the penalty associated with the individual mandate. She was hoping that I could figure out how to make their income low enough so the insurance premiums were more than 8% which triggers an exemption. The parents of this upper income family were seriously considering not providing health insurance to their children. That is just so irresponsible.