Within the debate over healthcare reform in the U.S. are conflicting philosophies regarding how the system should operate and who ultimately should make health care decisions. The Washington state legislature during recent sessions has sought to bring down patient costs with greater government control over health care plans while directing a work group to study a possible universal or single payer system.
As health care spending in the U.S. is expected to rise in the coming decades, Washington Policy Center Health Care Policy Analyst Dr. Roger Stark said during a Sept. 9 webinar that the system is “at a crossroads” with two ideologies: “More government control, more government intervention – o give patients more control over their health care, their health care dollars and their health care decisions.”
Health care spending in the U.S. has increased since 1960 from five percent of gross domestic product (GDP) to 18 percent in 2018. It also spends more on health care than most countries in the world. Much of the increased spending occurred when the Affordable Care Act (ACA) was implemented in 2014-15.
Aside from costs, many of the arguments made by single payer advocates focuses on coverage and the ability to get insurance despite preexisting conditions—something they believe a universal system would remedy. They also argue that placing everyone on a single plan simplifies the system and lowers overall costs; relative to its economy, Canada spends 11 percent of GDP on health care.
“It seems simple,” Stark said. “No insurance. No worries about whether a doctor can see you or not.”
While conceding that the preexisting condition policy under the ACA remains popular among the American public, Stark said that this has led to higher premiums for everyone else. “Insurance companies don’t know who is in the high-risk pool, so they charge everyone high.”
He said one possible solution is to place those people within a specific program for high-risk individuals. “We could isolate them and provide insurance but put them in a different risk pool. Then everyone’s premiums will go down.”
However, he reiterated points he has made in the past that a universal system like the one contemplated by the state work group will fail. The primary reason is cost; the states of Vermont and California sought to implement a single payer system but were unable to appropriate the necessary money. One study concluded it would cost $28 billion in Washington state to achieve a universal system.
“Washington state is not unique,” Stark said. “There is no funding mechanism that makes sense.”
He also believes Americans would reject the reduced health care quality that rationing via a single payer system would create. Although the U.S. spends more on health care than Canada relative to their respective economies, wait times between seeing a primary doctor and treatment in the U.S. is less than a month compared to five months in Canada.
“That would not be acceptable to citizens of the United States,” he said.
Washington state lawmakers last year enacted a law that requires several standardized plans be created through the Washington Health Care Exchange that cap deductibles and increases the number of medical visits an insurance provider must cover.
However, Stark said “what we need is patients to have control over their healthcare dollars and make their own decisions in concert with their providers.”
He cited numerous examples of positive changes made via executive order by Governor Jay Inslee that include suspending a certificate of need requirement to build long-term health care facilities.
“We’re hopeful that these kinds of things would persist,” Stark said. “I’m not sure they will, but potentially this could be a major shift in healthcare reform.”
In addition to its ongoing webinar series, WPC will host a virtual dinner on Sept. 25 featuring Hon. Trey Gowdy and Gov. Rick Perry.