HealthCommentary

Exploring Human Potential

“blank”…. FOR ALL.

Posted on | February 11, 2019 | No Comments

Mike Magee

In a Washington Post interview this week, Rep. Donna Shalala, former head of HHS and now a member of Congress from Florida, suggested that democratic reformers focus on universal coverage by whatever means possible. In her view, this includes opening up voluntary access to Medicare (50+), Medicaid (more liberal entry standards), employer based insurance (for employees kids up to age 30),  ACA exchanges (with increased subsidies to enhance affordability), and reinforced CHIP.

Without saying it, Shalala and others believe that you don’t have to strong arm people or restrict choice of coverage to make progress. You just need to offer them better options. Her major point, forged by the pragmatism of someone who has been in the battle for a long, long time, is that mandated universal coverage or the “blank…FOR ALL” is what matters – through whatever means possible.

She cites as one example the natural expansion of ACA funded Medicaid which has now been adopted by 37 states (including D.C.), leaving only 14 (out of 33) Republican governor hold out’s.

Despite Trump’s attempts (echoed vigorously on FOX News) to brand efforts to establish “Medicare-for-all” the way Medicare was attacked a half century ago as big government “socialized medicine”, the majority of governors has tacitly acknowledged what Warren Buffett was right when he described the health care status quo as “the tapeworm of American economic competitiveness”.

The decline of state economies reinforced by the burden of weak social service systems, challenged and undermined by a raging opioid epidemic, had caused Republican governors like John Kasich to declare independence when it came to health policy.

Expanded Medicaid celebrated a new approach (within the corridors of defined eligibility) of universality, access, health planning, portability, and integration with other social service programming. Participating governors liked the fact that the program was well funded, that the benefit package was broad (not a sham skimp HSA product), and that they preserved the flexibility within bounds to set the priorities on spending and were allowed to define how best to advance the overall health of their state populations.

The governors learned that centralized administration of a universally available health insurance offering carried distinct cost savings. Specifically, governor guided single payer health delivery under Medicaid came in 22% less costly than privately insured comparators.

Participating governors well understand that the U.S. is the only civilized nation in the world where more is spent on the mechanics of disease fighting than on all social services combined – the very combination of services and supports that help keep a population well.

Given the power and flexibility under Medicaid, they can redeploy essential human health resources. For example, as wildly expensive nursing home use declines, those employees, now mobile are a potentially useful and experienced mobile home services health corps. Given room for experimentation, as they have been under the ACA, governors have applied both innovation and structural remodeling to expand safety, security, and health across multi-generational families.

Despite Trump and McConnell opposition, The Medicaid single payer authority experiment has gone large scale. Under the direction of autonomous state leaders, nearly 80 million have received care of late with extraordinary high satisfaction levels. 34 million of these citizens are children. 2 million new citizens will be ushered into the human race this year through Medicaid prenatal and obstetric coverage. 9 million blind and disabled citizens sleep easier each night thanks to the governors. Nearly a third of the states structure offerings through a managed care approach. All integrate physical and mental health, including addiction services.

Trump and his followers may be intent on creating chaos, promoting regressive legislation, and reimagining reality, but governors in most states are laser focused on solutions – and the more they experience single payer authority and efficiency, and benefit from integrated health planning, the more they and their citizens like it.

So it’s well to remember that it’s not whether you are for or against “Medicare-for-all” that matters. What really matters is that there be central oversight, uniform high standards, careful public health planning, integrated care, and  – above all – that comprehensive health insurance be mandatory all-for-one and one “… FOR ALL” .

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