Options for Dialing Down From Single Payer

There are formidable institutional obstacles to passing a single-payer health program in the United States. Advocates should consider incremental improvements that may better match legislative realities. There are three potential directions for incremental coverage policy.One possibility is to build...

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Bibliographic Details
Published in:American journal of public health (1971) 2019-11, Vol.109 (11), p.1517-1520
Main Author: Glied, Sherry
Format: Article
Language:English
Subjects:
AJPH Financing Health Care
Containment
Cost Control
Employers
Federalism
Government programs
Health Administration
Health care policy
Health insurance
Health Law
Health Policy
Health Reform
Humans
Incentives
Insurance
Insurance coverage
Insurance, Health - economics
Insurance, Health - legislation & jurisprudence
Insurance, Health - organization & administration
Legislation
Legislators
Medicaid
Medicaid - legislation & jurisprudence
Medicare
Patient Protection & Affordable Care Act 2010-US
Patient Protection and Affordable Care Act - economics
Patient Protection and Affordable Care Act - legislation & jurisprudence
Patient Protection and Affordable Care Act - organization & administration
Politics
Public health
Security
Single-Payer System
State Government
Subsidies
United States
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Summary:There are formidable institutional obstacles to passing a single-payer health program in the United States. Advocates should consider incremental improvements that may better match legislative realities. There are three potential directions for incremental coverage policy.One possibility is to build on the successes of the Affordable Care Act; this might include rolling back regulatory changes, further incentivizing Medicaid expansion, enhancing coverage in the Affordable Care Act marketplaces, and imposing regulations on private employer-based insurance to ensure that all Americans have access to affordable coverage that provides adequate financial security. A second direction is to offer more publicly sponsored insurance options, which might involve offering a public option to those eligible for marketplace coverage, creating a Medicare or Medicaid buy-in program, lowering the eligibility age for Medicare, or developing a public plan that serves as a default for those who do not choose to buy alternative private coverage. A third direction is to build on federalism, offering states incentives to expand coverage.Federal and state legislators could also consider incremental cost-containment steps, such as rate setting.
ISSN:0090-0036
1541-0048
DOI:10.2105/AJPH.2019.305299