How To Simplify Health Insurance In The U.S. |
While Congress and President Trump debate how much the government should subsidize certain health insurance premiums, they are missing a far more important question: How can the U.S. rationalize our eight (at least) completely separate health insurance systems?
This maze-like complexity comes at a price. Dividing Americans into multiple risk pools increases health care costs. It means patients lose access to trusted providers. And it seems impossible to have an honest debate about a health insurance system that almost nobody understands.
Most other developed countries generally avoid this chaos. Some rely on government-run, single-payer systems while others use regulated private insurers. And we could have a healthy argument about which is best.
But over the past 80 years, the U.S. has patched together a quilt of public and private insurance, with separate coverage for different groups. If you are keeping score, we have:
This tax-favored system accidentally became the default insurance program during World War II. Today, it covers about 165 million Americans, making it by far the largest form of health insurance. It may be offered as managed care or through relatively open provider networks, though quality varies widely by employer.
The 2010 law covers about 24 million people who don’t have employer-based or government coverage. The ACA has three separate plans and multiple levels of income-based subsidies (perhaps you heard about them in recent weeks).
For very low-income people, Medicaid and its related children’s health insurance program covers about 77 million people. Each state sets its own rules within a broad........