A bill bringing global budgeting and all-payer pricing was aired in an Illinois senate committee yesterday. This post includes my 3-minute statement supporting the measure.
One relatively new reason to support the Maryland model: even if we get past the current corrupt fascist administration, will we ever be able to trust the federal government in our lifetimes? All-payer can be as effective as single payer, and at this stage in our national devolution, decentralization provides some protection.
Uwe Reinhardt famously said that the U.S. government was too corrupt to make single payer a prudent model here. That's truer now than it was in his lifetime.
... and we don't NEED single-payer. What we need is single-pricing. In fact, I think we need to STOP promoting/advocating for single-payer (including M4ALL) because it is just so easy to defeat politically (as "socialized medicine" AKA NHS in UK). At least it has been for the last 80 years ...
100% agree with you on Maryland All-Payer model - BUT - doesn't it require a CMS waiver so that Medicare patients can be billed at the higher All-Payer rate? Worth noting too - when pricing is regulated in this way (which isn't in a vacuum - it is negotiated), no one really cares how many payers there are. Nor should they. Single-payer works (of course), but we don't need it to get essentially the same result - single-pricing: http://hc4.us/oneprice
A waiver (plus additional government support, which only Maryland gets) is necessary to gross up Medicare and Medicaid prices to a common price. But a state-based all-commercial payer pricing bill could be established without subsidy or waiver of done as a percentage of public prices. I’ve also developed a state-based tax as ruin plan to recapture some of the savings from employers, which would be distributed through the global budgets based on need (safety nets, rural hospitals, primary and behavioral care, etc.). By establishing all payer commercial pricing through regulation of hospitals, you’ll get around ERISA, which prohibits state regulation of insurers or the self-insured with multi-state plans.
Seems like - one way or another - taxpayers are on the hook - no? We're all paying for Maryland's CMS Waiver - the difference is - that would shift to the individual states?
The problem is ... All-Payer (at least in Maryland) doesn't include:
* Independent physician fees
* Ambulatory Surgical Centers (ASCs)
* Drug pricing
... AND ... guess which state has the highest number (per capita) of ASCs? Yup. Maryland (~5.5 per 100,000).
One relatively new reason to support the Maryland model: even if we get past the current corrupt fascist administration, will we ever be able to trust the federal government in our lifetimes? All-payer can be as effective as single payer, and at this stage in our national devolution, decentralization provides some protection.
Uwe Reinhardt famously said that the U.S. government was too corrupt to make single payer a prudent model here. That's truer now than it was in his lifetime.
... and we don't NEED single-payer. What we need is single-pricing. In fact, I think we need to STOP promoting/advocating for single-payer (including M4ALL) because it is just so easy to defeat politically (as "socialized medicine" AKA NHS in UK). At least it has been for the last 80 years ...
http://hc.4us/oneprice
100% agree with you on Maryland All-Payer model - BUT - doesn't it require a CMS waiver so that Medicare patients can be billed at the higher All-Payer rate? Worth noting too - when pricing is regulated in this way (which isn't in a vacuum - it is negotiated), no one really cares how many payers there are. Nor should they. Single-payer works (of course), but we don't need it to get essentially the same result - single-pricing: http://hc4.us/oneprice
A waiver (plus additional government support, which only Maryland gets) is necessary to gross up Medicare and Medicaid prices to a common price. But a state-based all-commercial payer pricing bill could be established without subsidy or waiver of done as a percentage of public prices. I’ve also developed a state-based tax as ruin plan to recapture some of the savings from employers, which would be distributed through the global budgets based on need (safety nets, rural hospitals, primary and behavioral care, etc.). By establishing all payer commercial pricing through regulation of hospitals, you’ll get around ERISA, which prohibits state regulation of insurers or the self-insured with multi-state plans.
Seems like - one way or another - taxpayers are on the hook - no? We're all paying for Maryland's CMS Waiver - the difference is - that would shift to the individual states?
The problem is ... All-Payer (at least in Maryland) doesn't include:
* Independent physician fees
* Ambulatory Surgical Centers (ASCs)
* Drug pricing
... AND ... guess which state has the highest number (per capita) of ASCs? Yup. Maryland (~5.5 per 100,000).
Congrats on your testimony and thank you for this ray of hope. Here’s hoping the bill finds its way to the governor’s desk.