3 ms·

It also prevents some of the anticipated benefits of the single-payer system. - Providers don't realize the anticipated reductions in administrative overhead,

by cosmie 7y ago

It also prevents some of the anticipated benefits of the single-payer system. - Providers don't realize the anticipated reductions in administrative overhead, since they may still need to retain the same complexity in billing but just with a radically different distribution of claims. - Consumers may still end up having issues with providers accepting plans. Especially if you leave a loophole that allows providers to decline the single-payer option but accept the private versions that cover the same service. - Consumer confusion can come into play related to covered services. One potential draw of the private version would be lax qualification standards for a specific coverage item. But if they decline coverage and the consumer tries to fallback on the single payer system, they may not have gotten the proper approvals or step therapy to have the procedure covered. The private company will have a marketing department to ensure negative consumer sentiment ends up falling on the lap of the single payer system. - Economies of scale. The single payer system has market power specifically explicitly because of the fact that they own the whole consumer pool. If you allow it to remain fragmented, it lowers the single payer's negotiating power. - Risk pool. The private company is more likely to skim off the healthiest consumers from the risk pool, and leaving the unhealthiest. This causes all kinds of issues from a political standpoint. The private companies can offer more attractive "perks" (like covering the same procedure, but streamlining the qualification process) because their risk pool is less likely to actually need that procedure. This would incentivize the top end of the market to purchase the plans (or offer as employee benefits, such as now), who would then feel negatively about the single-payer option because they're being forced to pay into that while not actively using it since it appears "worse" (even though it covers the same things). At the end of the day, the clause isn't strictly necessary for a single payer system. But without that clause, you introduce quite a few failure modes and unnecessary friction points that can be completely avoided by simply disallowing duplicative private policies from being sold.

sanderjd 7y ago
All of your points except the first one seem more relevant to the debate between single payer vs. multi payer. But I'm specifically asking, assuming single payer (ie. without a loophole that makes it multi payer), why is it necessary to proactively outlaw other plans rather than let them die? I think your first point kind of gets at the crux of it though: you want providers to only have to support a single payer in order to reap the administrative efficiencies, so you either need to make a law that says that providers must only accept payments from the single national plan, or that insurers can't offer plans that pay separately. Those two options seem equivalent to me, but the first one (forcing providers to only accept payments from the national plan) seems more intuitive than the second to me.
- cosmie 7y ago
  For sure, the first point is pretty critical to ensure market viability of a single payer system. The potential reductions in administrative overhead absorbs some of the expected reductions in reimbursement amounts that'd come with a single payer system. But even if you can make it work out from an economics standpoint, it can ultimately fail from a political standpoint if people feel like it's a failure. And there are a lot of entrenched interests that would benefit from a failed single payer experiment. My other points were geared towards that component. Letting the multi-payer environment die out organically leaves a grey area with potential consumer confusion and frustration during the transition period, and also leaves the infrastructure in place to easily roll back the single payer plan if you adequately exploit that frustration. Forcefully cutting over to a single payer system allows a clean break so both the consumer and provider side of the market has the opportunity to validate if the claims in the single vs. multi payer debate can be realized, without creating a giant attack surface for political and market shenanigans that could kill it before it really got going. It also raises the level of effort required to roll back the single payer system, since the infrastructure and and staffing to support it is reduced more rapidly than if taking a "let them die on their own" stance.

by cosmie 7y ago

sanderjd 7y ago

All of your points except the first one seem more relevant to the debate between single payer vs. multi payer. But I'm specifically asking, assuming single payer (ie. without a loophole that makes it multi payer), why is it necessary to proactively outlaw other plans rather than let them die? I think your first point kind of gets at the crux of it though: you want providers to only have to support a single payer in order to reap the administrative efficiencies, so you either need to make a law that says that providers must only accept payments from the single national plan, or that insurers can't offer plans that pay separately. Those two options seem equivalent to me, but the first one (forcing providers to only accept payments from the national plan) seems more intuitive than the second to me.

cosmie 7y ago
For sure, the first point is pretty critical to ensure market viability of a single payer system. The potential reductions in administrative overhead absorbs some of the expected reductions in reimbursement amounts that'd come with a single payer system. But even if you can make it work out from an economics standpoint, it can ultimately fail from a political standpoint if people feel like it's a failure. And there are a lot of entrenched interests that would benefit from a failed single payer experiment. My other points were geared towards that component. Letting the multi-payer environment die out organically leaves a grey area with potential consumer confusion and frustration during the transition period, and also leaves the infrastructure in place to easily roll back the single payer plan if you adequately exploit that frustration. Forcefully cutting over to a single payer system allows a clean break so both the consumer and provider side of the market has the opportunity to validate if the claims in the single vs. multi payer debate can be realized, without creating a giant attack surface for political and market shenanigans that could kill it before it really got going. It also raises the level of effort required to roll back the single payer system, since the infrastructure and and staffing to support it is reduced more rapidly than if taking a "let them die on their own" stance.