Affordable Care Act
Published in The Journal Record
October 23, 2019
Most people, when asked about their death, commonly respond that they would like to pass away quietly in their sleep at a very old age, not having suffered any lingering illnesses. A quick quiet death is preferable to a long painful one. If we can judge by the rhetoric of the Democratic candidates for president we are in the process of choosing between a quick death for private health insurance if Medicare for All is passed, or a slow lingering passage if the more conservative candidates have their way and a public option is draped around the Affordable Care Act (commonly referred to as Obama Care).
The public option is an idea that was floated during the debate over ACA but was never included in the final legislation. The basic concept is that the federal government would be able to compete with private insurance in a competitive marketplace where individuals and companies would have the choice of selecting a Medicare-like program or plans offered by private insurance companies. What could be fairer? The insurance companies and the government could compete heads up for America’s insurance business. There is, however, one significant problem. Currently medical providers in this country negotiate with private insurance companies on pricing. Larger, more powerful, and more complex health systems have an advantage in this negotiation than small rural clinics and hospitals.
The point is, there is a negotiation. In the Medicare program there is no negotiation. The government decides what they will pay, and providers can either accept it or refuse to take government funded patients. In a public option program this gives the government huge advantage on the cost of coverage. Because of this advantage private insurance will soon find it cannot compete because the government’s ability to purchase services at far cheaper rates. What this means, of course, is that over time private health insurance would be at such a disadvantage that they would find themselves in an impossible competitive position. This would lead to a slow death of private insurance. Medicare for All essentially eliminates all private insurance. A public option eventually squeezes all competitors out of the market. Either way America ends up with a single-payer system.
Take your pick, a slow or a quick death.