Badger Club tackles health insurance issues

In the United States, it is well understood that we spend more per capita for health care than any other country, our health outcomes compared with other industrialized countries are mediocre and we don’t cover everyone.

We have a multi-payer system of employment-based coverage, Medicare, Medicaid, the Affordable Care Act, and then we have the uninsured. The fact that our system is multi-payer, in and of itself, is not a problem. But, our system is broken.

The Affordable Care Act, passed in 2010 and fully implemented in 2014, has significantly reduced the number of uninsured in the U.S. Most of that comes from the expansion of Medicaid. The ACA was primarily about changing and expanding coverage. It included a new set of standards for health coverage that all plans had to meet. It eliminated annual and lifetime caps on coverage, and perhaps the most significant change was the elimination of pre-existing conditions as either an impediment to obtaining coverage, or a justification for a higher premium.

Unfortunately, even in a state like Washington, which completely embraced the ACA, the results have been less than expected. Statewide, the uninsured population has been reduced by half, but for Benton and Franklin counties the reduction was 20 percent.

For much of this year, national politics has been consumed by attempts to replace the ACA. Even ardent supporters of the ACA acknowledge that there are shortcomings in the law that need to be addressed, but the highly partisan nature of Congress that we have seen for many years makes compromise an unlikely outcome.

Medicaid, which covers more than 1.8 million people in our state, includes no out-of-pocket costs for covered individuals.

In 2012, because of the significant volume of nonemergent ER visits by Medicaid beneficiaries, Washington planned to not pay for more than three such visits a year for a covered individual.

For years, virtually all private insurance plans have had an additional deductible or copay for people who went to the ER for nonemergent needs. This is an attempt to steer behavior to less-costly options. No such elements exist in Medicaid in our state. The state backed away from this plan, which would have simply shifted the burden to hospitals that had no way to prevent these visits as they are required by law to see anyone who comes regardless of their ability to pay.

Today we are hearing more and more voices calling for single-payer. Bernie Sanders is advocating for Medicare for All, although his proposal goes far beyond the current Medicare system in terms of coverage and out-of-pocket costs.

Single-payer would significantly reduce some of the administrative costs for providers and would eliminate much of the overhead that exists in health insurance companies. One of the key questions becomes how to pay for it.

Others would like to see a greater role for consumer choice and the marketplace, believing that this would help drive down costs. We do not acquire healthcare services in a manner similar to which we purchase anything else.

One criticism of market approaches is that we can’t shop for price when in the ambulance on the way to the hospital, which is absolutely true. But it is just as true that much of the healthcare services that are used are elective, and comparisons could be made. Unfortunately, the information to compare price and outcomes is not available to us.

On Thursday, Oct. 26, the Badger Club will present a forum with speakers on both free-market and single-payer approaches to improving our healthcare system.

This story was originally published October 21, 2017 at 2:51 PM with the headline "Badger Club tackles health insurance issues."