Aetna's talking "single-payer"

Aetna Chairman and CEO Mark Bertolini said Thursday in a private meeting with his employees that the U.S. needs to have a debate about how a single-payer health system would be structured, including the possibility of administering the system by partnering with private insurers.

Bertolini raised doubts about whether the government should run the entire healthcare system, and alluded to a similar structure seen in Medicare Advantage or Medicaid Managed Care, which involves private companies.

"The government doesn't administer anything," he said in statements first reported by Vox. "The first thing they've ever tried to administer in social programs was [Obamacare], and that didn't go so well. So the industry has always been the back room for government. If the government wants to pay all the bills, and employers want to stop offering coverage, and we can be there in a public private partnership to do the work we do today with Medicare, and with Medicaid at every state level, we run the Medicaid programs for them, then let's have that conversation."

"But if we want to turn it all over to the government to run, is the government really the right place to run all this stuff? And that's the debate that needs to be had," he said. "They could finance it, and if there is one financer, and you could call that single-payer."

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Greenbeard said:

Fair enough. Let me fill you in on what "single-payer" would look like in the United States, based on 50 years of evolution of existing single-payer programs in this country.

It will look like some mixture of Medicaid managed care (which enrolls the majority of Medicaid beneficiaries today and more every year) and Medicare Advantage (a very fast-growing segment of the Medicare population that enrolls nearly a third of beneficiaries today). Both are essentially privatized versions of the original Medicare and Medicaid programs. It will involve the government providing capitated payments--i.e., paying a monthly premium for enrollees--to private, often for-profit, insurance companies. Those insurance companies will compete for enrollment and will either pay providers largely in accordance with a government-set fee schedule (Medicare Advantage) or through their price own negotiations with health care providers as in the commercial market (Medicaid managed care).

The government will have a policy-setting role but the program will be based on some simulacrum of a market-based system; beneficiaries, for instances, will likely choose their plan in an exchange structure as under the ACA. They may see a relatively fixed taxpayer contribution, ala the Ryan Medicare reforms, or it may be structured more generously. Either way, there will likely be choices--yes, variation in cost-sharing and covered benefits--allowing those who wish to pay more for more generous coverage to do so.

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Greenbeard said:

These are interesting times. Not too long ago, Aetna famously stopped selling commercial plans in certain exchanges as a political and legal ploy to bolster its move to corner the Medicare market by acquiring Humana (Humana is essentially a Medicare insurer at this point as nearly three-quarters of its revenue comes from it Medicare lines of business).

Now Aetna wants a "debate" on moving to single-payer, by which they apparently mean converting to public financing of all their lines of business. Their "ditch commercial to shore up Medicare business" strategy writ large.



That's more or less what I assume American "single-payer" would look like: an overwhelmingly publicly financed multi-payer system. To quote a post from 14 months ago:



Whether that direction is good or bad is a very large question, but I suppose it's beginning to seem more plausible these days.

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reinoe said:

There must be out of pocket expenses for the user of healthcare. There absolutely have to be otherwise costs will increase exponentially.

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joG said:

I will have to look more closely, but it sounds as though they might be looking for a publicly organized cartel.

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Roadvirus said:

It's amazing how much of a disaster 1 single issue can turn into. And to think some people thought Abortion was the FUBAR issue.

I was discussing this with some friends of mine. I brought up the whole Trumpcare thing and one guy said it sucked. I and another friend said basically "so does Obamacare".

But in the end, we all agreed that no matter what the solution, it'll never be perfect. Mainly because there are so many lobbyist dicks with stakes in it hoping for a piece of whatever they can get out of it.

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