‘Single-Payer’ Healthcare Isn’t Necessary — But Single Pricing Is | Forbes


Once again, our healthcare reform is mired in muck. That means we’re also knee-deep and grinding away at our circular healthcare debate, but it’s really a big distraction because it’s the wrong debate. We keep debating the math of coverage and cost as if they’re independent of system design–and they aren’t. As Senate Majority Leader Mitch McConnell is finding out, there’s no solution to the Rubik’s Cube he’s playing with, because it’s the same one we’ve been fiddling with for decades–tiered coverage to support tiered pricing. The only way to lower the cost is to end coverage (how and for whom are just the dials). The good news is that “single-payer” healthcare isn’t necessary to solve our healthcare cost crisis. The bad news is that single pricing is, and that will require systemic change.

What we have is tiered coverage designed to support tiered pricing. It’s not just complex for everyone, it’s totally opaque. Medicare, Medicaid, VA, Indian Health Services, employer-sponsored insurance, Obamacare and the uninsured are all different tiers of coverage–with different pricing. That works well to maximize revenue and profits, but the enormous sacrifice to this design is safety, quality and equality. A big myth surrounding the debate is that our system is just broken. It’s not. It’s working exactly as designed, and we need a different system design based on the core principle of universal coverage.

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‘Single-Payer’ Healthcare Isn’t Necessary — But Single Pricing Is.