The Heritage Plan to a single-payer system?

[kentuck]

What are the differences between the present ACA law and the Heritage Foundation plan from the 1990's?

As I recall, it was presented as a substitute for "Hillarycare". However, with a concerted PR effort by the right-wing, Hillarycare was defeated in the battle for public acceptance and the Heritage Plan never came up again. Not until Barack Obama took it as his blueprint for healthcare reform.

But why are Republicans against it now? And why are Democrats for it now?

Republicans say it is the road to a single-payer system. Do they know that the private insurance system cannot function efficiently in such a system as proposed in the ACA law? Is it possible to cover all of America and to offer healthcare and still offer insurance companies huge profits? Is it possible to mix oil and water?

The problem is with those poor folks that pay nothing for their coverage. They get subsidized with Medicaid. But somebody has to make up the difference. That is the problem the insurance companies face. What fees do they raise and what deductibles do they increase to make up the difference? And how do they operate in the black when they can "only" keep 20% of their profits for themselves and have to spend 80% on healthcare?

How does this lead to a single payer system? How do we get the insurance companies out of the healthcare business?

[grahamhgreen]

1. Individual states can create SP systems (Vermont is doing so), nationally we should have a public

Option.

Check out pnhp.org

[CTyankee]

2. It seems to me that once people get into Obamacare, they will never go out to private insurance

in the same way, because it will change the system whereby your employer paid your premium (or part of it). Businesses will see the virtue in this. But insurance companies will have to compete for customers and some of them will die. Insurance companies will tire of this "race to the bottom" and begin to specialize in "boutique" health insurance for those wanting it and willing to pay for it. Eventually, the whole system will topple and we will have single payer, because it makes good sense for people and for businesses.

[libdem4life]

3. I think/hope/have read that the setting up of state exchanges is big part of the "slippery slope"

to Single Payer... yeah ... by getting HHS and State and County systems functionally connected. (also VA and Medicare) There are already a lot of established government-funded health care institutions.

Could also be a chance for insurance companies to ratchet down their health care cost inflation voluntarily. There is a place for these companies that do absolutely nothing but shuffle paper and collect money. Kind of like tobacco farms and cigarettes, they'll either adapt or die. Some will likely morph into the ACA system where the expertise will be useful, while being regulated.

It is not the actual cost that is skyrocketing, it is the profit. They had/have a triple billing system...one for insurance pay, one for private pay, and one for writing off their uncollectibles and ruining the patient's credit.

When there was little shopping or competition, they could and did raise fees without abandon...nothing most could do about it.

[Cleita]

4. Actually it is possible to mix oil and water.

The French do it and we do it with traditional Medicare. They cover everyone, rich or poor, with basic health care that covers 80%. Then, one must purchase private insurance to cover the 20% or the government will cover that if you are poor, under a certain income level. However everyone else can purchase insurance that will cover everything, the 20% or even more like luxury hospital rooms,
private nurses etc. if you are rich. The sky's the limit for whatever coverage you want beyond the basic. It appeals to the wealthy who don't want to share facilities with the common people.

Insurance companies, however, are forbidden by law to try to offer basic coverage or to try to privatize the government part of it like we do with Medicare Advantage plans. They also allow the insurance companies to get contracts with the government to process claims. We also do this with Medicare and Medicaid.

The reason the French did this was because they knew the insurance companies would not let go, but this way it includes them but keeps them under government regulation and controls costs. I think it's worth looking into.