Single-payer reform is in the news—and in the U.S. House and Senate. One hundred twenty-three Congresspeople have signed on as co-sponsors of
H.R. 676, the single-payer legislation in House of Representatives, and 16 Senators have formally endorsed
S.1804, the Senate version. (Disclosure: H.R. 676 was closely modeled on the Physicians for a National Health Program reform proposal
published in JAMA, for which we served as lead authors).
While both bills would cover all Americans under a single, tax-funded insurance program, they prescribe different provider payment strategies. The Senate version largely adopts Medicare's current payment mechanisms; the House bill's is modeled on Canada's single-payer program, also called "Medicare," which pays hospitals global budgets (much as a fire department is paid in the U.S.) and sharply constrains opportunities for investor-owned care [...]
In contrast, the House bill would abolish per-patient billing by hospitals and other institutions, and its global budget payments would cover only operating costs; hospitals would be prohibited from retaining surpluses, and capital investments would be funded through separate government grants. The bill would also explicitly proscribe payments to investor-owned facilities, and it calls for their conversion to non-profit status financed by issuing bonds [...]
In sum, the financial viability of a single-payer reform turns on cutting administrative costs and minimizing incentives for financial gaming. Maintaining Medicare's current payment strategies, as under S.1804, would be substantially costlier than adopting the non-profit global-budgeting strategy used in several other nations [...] The House single-payer bill envisions a buyout of the investor-owned facilities needed to provide care under the single-payer system, while the Senate version would leave them in current hands.
Proponents of the House approach acknowledge that many non-profit health care organizations have drifted far from their charitable roots. However, they cite evidence that for-profit providers (including hospitals, dialysis centers, nursing homes, home care agencies, and hospices) provide inferior care at inflated prices (see, for instance
here,
here,
here,
here and
here) and are more likely to bend care to profitability (see
here, here, here and
here). For-profit hospitals spend less on nurses and other clinical aspects of care, but
more on administration and financial management; for-profit chains have often been cited for
questionable business practices and have been repeatedly implicated in large scale fraud (see
here,
here,
hereand
here)[...]
Link:
https://www.healthaffairs.org/do/10.1377/hblog20181116.732860/full/
