Archive for October 2013

Single Payer Healthcare Initiated On a State by State Basis (?)   Leave a comment


Single Payer Healthcare Initiated On a State by State Basis(?)


October 30, 2013 at 8:55am


Some have promoted the concept that a single payer healthcare insurance plan such as H.R. 676 may have to be accomplished on a state by state basis. It has been pointed out that Canada established a national healthcare plan when one province led the way and the other provinces followed suit. I am not convinced that with 50 states in the United States in comparison to the much fewer number of provinces in Canada that any correlation can be made in this regard. However I thought that perhaps a good look at the possibility might be in order and that maybe we need to have a conversation on the topic.

Suppose that one state decides to institute a single payer state financed healthcare insurance program for its residents? For the sake of this discussion we will assume that the legislation is the same as what is proposed in H.R. 676. I think that one must keep in mind that each state is unique and that there are many factors that need to be taken into account which may differ from state to state. This exercise then, of necessity, will be one of generalities rather than specifics.

Lets look at the potential positive and/or negative consequences in the event that a state adopts a single payer healthcare insurance plan:

1) Corporations/businesses may see the potential savings as they would not be burdened with providing healthcare insurance for their employees and their families. This may lead to a migration of businesses into the state. This would only occur if businesses could see that the savings from the freedom of providing healthcare benefits would be greater than the tax necessary to support the healthcare plan. Overall businesses would have an economic advantage over their competitors on the national and the international level.

2) Employees may see that they would be dollars ahead in paying the extra tax over paying their insurance premiums and migrate to the state. This may occur especially from adjacent states as the employee could work in one state and reside in the state with the healthcare insurance plan. Question: since the tax would be a payroll tax how would the state of residence collect it in order to provide services?

3) Everyone in the state would be able to access any licensed/accredited healthcare provider without the fear of cost. This would possibly lead to better preventive care which would lower healthcare costs in the long term. It would also eliminate the harm done to our economy when families have to declare bankruptcy and/or go into foreclosure due to medical bills.

4) H.R. 676 allows for the government to negotiate prices for pharmaceuticals and medical equipment/supplies. I am not sure that any state would have the authority or power to enact this portion of the proposed legislation. This may be a negative factor in regard to a state by state approach.

5) The unemployed and very poor may migrate to any state that enacts single payer. This may stress the resources for any state that would attempt to lead the way to single payer.

6) Funding would have to be adequate to support single payer for any state that adopted it. Funding already available would be Medicaid and Medicare funds as those populations would be provided healthcare through the new single payer insurance plan. The Federal Government could continue to provide the same dollars for the single payer plan that they are currently providing for Medicaid and Medicare. Question: would veterans in the state continue to be served through the VA Medical Admin or would they be served by single payer? Perhaps the state could work out an agreement with the VA Medical Admin so that the funds they would normally expend would go to support the single payer plan. It would be hopeful then that the increase in tax would be the same that is proposed in H.R. 676 and that it would be adequate to the needs of the single payer plan.

I am sure that there are other concerns, questions, factors, perspectives, positives and negatives that I have not thought of or listed. This is by no means a complete or thorough analysis of the possibilities or issues concerning single payer healthcare. The great majority of Americans…conservative, liberal, libertariian, progressives, etc…agree that our nation’s healthcare financing system is broken. The disagreement is how to fix it. May we come together to dialogue in order to create a better and more equitable and just healthcare financing system. May we set aside our preconceived, partisan, ideological, biased opinions/positions and work together in this important task. Your thoughts and comments are welcome.


Posted October 30, 2013 by terryflowersblog in Health Care