May 23, 2017
Over the next few months we'll likely see passage of new laws relating to how we deliver and finance healthcare in this country. One of the issues that is being hotly debated is whether the reforms should include the option for folks to choose a healthcare plan provided through the government. That "public option" could take the form of extending Medicare or some other type of government healthcare plan such as that provided for federal employees or those in the military. Private health insurers have made it clear they don't like the idea of having to compete against such a government plan. They may have some good reasons for feeling that way. How such a public option would affect both citizens and private insurers will depend on the details of the proposals. It's far from clear that a public option will be included at all in the final form of the legislation. One of the best discussions I've seen about the public option is this from the Anonymous Liberal blog.
I am confident that the political will doesn't exist for a single payer plan and I'm not sure it would be the best thing for the country even if it were a more realistic alternative. But given my own experience on a day to day basis wrangling with health insurers and self funded plans about denied medical claims, I'm skeptical about proposals that achieve universal coverage by simply extending the status quo through tax credits or subsidies. The amount of money we spend on lining the pockets of health insurance executives and shareholders is mind boggling. Compared to a single payer system, there are a number of ways in which our capitaliist approach to health insurance is inefficient.
Reforming our national healthcare delivery system is extraordinarily complex and I don't have any great insight into more than a few angles of it. While a single payer system would likely dry up a significant portion of my law practice, I wish we were debating it more seriously because I think there are some aspects of it that would create a lot more cost efficient way of getting healthcare provided to those that need it most. For example, see this excellent Phillip Longman article on the VA healthcare system in The Washington Monthly from a few years ago.
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