Getting To Universal Coverage

One of the signature proposals in Bernie Sanders' campaign is universal health care coverage, or "Medicare For All" as he likes to describe it. While the actual cost of bringing Medicare For All to fruition has been a subject of some debate during the campaign, the political hurdles are also enormous.  The lobbying power of the big pharmaceuticals, insurance companies, hospitals, and doctors together create a roadblock to most healthcare reforms.  The incentives, or some may say, giveaways, to insurers, hospitals, and pharmaceuticals were what allowed Obamacare to pass in the first place. And, as we can see from this latest story about even Democrats lining up against a perfectly reasonable effort to eliminate the financial incentives for doctors to prescribe the most expensive drug when a cheaper alternative is available, the lobbying power of these interest groups is immense. And, in this case, if I am reading it correctly, the big pharma and doctors are on one side and hospitals and insurers are on the other - even when the interests of these groups somewhat diverge, it is almost impossible to get reforms implemented.  And let's be clear, when we say lobbying power, we mean campaign contributions and/or media campaigns.

As it seems all but certain now that Sanders' will not be the Democratic nominee, the path to universal coverage would seem to be disappearing, although the issue will continue to be brought to the fore by Sanders and other progressives, especially focusing on the broadly popular idea of allowing the government to negotiate drug prices.  But the Affordable Care Act (ACA) may offer a slightly different path to universal coverage as it allows states to experiment with providing their own insurance plans.  Vermont had initially planned to provide a single payer option by setting up the state-run Green Mountain Care. But Democratic Governor Shumlin killed the program before it even got off the ground over concerns over cost. In Minnesota, there is a bill to have the state offer a Basic Health Plan (BHP) that would compete with other insurance plans offered under the state's ACA marketplace MNSure. As currently constructed, this new state plan would require a waiver from the federal government, but, if allowed, would offer exceedingly good coverage for the current price of a Silver Plan which, over time, could become the single-payer option for those who lack access to employer-based insurance plans. And in Colorado there is a measure on the ballot this November that would create a public health system that guarantees universal coverage.

As expected, insurance and pharmaceutical companies are already lined up in opposition to all the above programs. And conservatives worry that the costs will be overwhelming.  But, eventually, some state is going to have a single-payer option and when that happens, we will have a real-world example here in the United States that will give an indication of what those costs really are - it just may not be the way Bernie and his supporters wanted to get there.