If you are like me, you are sorely disappointed that Single Payer healthcare (Improved Medicare for All) is not the new law of the land. Instead, we have Obamacare (Affordable Care Act - ACA) which is insurance reform and a national subsidy to purchase insurance for those making less than 400% of the Federal Poverty Level (FPL). However, The Commonwealth Fund aptly points out that the ACA should not stop states from enacting their own version of a universal healthcare system.
Obamacare never focused on containing or reducing the overall healthcare costs; only on getting more people covered by some form of insurance. In fact, by 2014 it will be mandatory for everyone to show proof of coverage or be fined; which is only fair that everyone contribute to healthcare costs. After all, single payer healthcare requires everyone to participate, albeit through taxes. What isn't right is that Obamacare doesn't even offer an alternative to private for-profit insurance. And if it had provided the House's version of a public option, it would rapidly be subjected to "cherry picking" and therefore be priced out of the market.
As many people know, Obamacare requires that each state create and operate a "Healthcare Insurance Exchange". The Exchange must perform two primary tasks: (1) determine which individuals or small-businesses are eligible for which subsidies, and (2) create a minimum of two insurance plans that meet federal and state requirements.
However, and most importantly, Obamacare does not prohibit the states from (1) offering those two plans and others through a non-profit Insurance Authority or Public-Benefit Corporation (PBC) both within and outside the Exchange; (2) requiring all agencies and local governments that receive state funding to purchase their insurance through the Authority; (3) prohibiting the sale of any other healthcare insurance plan other than those which would be deemed supplemental to the state's plans or protected by ERISA (Employee Retirement Income Security Act), and (4) pricing those plans offered outside the Exchange at a progressive percentage of one's income.
The creation of the insurance authorities is no different from the time when PBCs or Authorities were first introduced in 1902 in England, or have been used to build railroads and interstate highways in the United States. Authorities are not owned by stockholders; rather they are "owned" by the state and funded by non-taxable interest bearing bonds backed only by the Authority and not the state. Authorities are also free to hire a highly qualified management team, to work closely with providers to reduce costs, and work with Healthcare Research and Quality Agencies to eliminate marginal or non-effective medicines, procedures and equipment.
These Authorities would have many advantages, not the least of which would be inaugurating a near universal healthcare system by 2014, two to six years earlier than a full blown single payer system could be attempted, which Obamacare prohibits until 2017. An insurance authority has many additional advantages: (1) it would go a long way toward reducing the current 30% in overhead costs associated with the private insurance industry; (2) it would be run like a private non-profit business funded by bonds without placing a "tax burden' on the state's residents; (3) it could easily be adapted to manage a future single payer program, and (4) it would eliminate the stigma of the government "bureaucracy" running healthcare.
Affordable universal healthcare has a history of starting at the state level. Tommy Douglas, in his Canadian Province of Saskatchewan, started with just universal hospital care.Hawaii has near universal healthcare by mandating insurance coverage (As ACA does in 2014); and have made it cost effective partly by authorizing only few comprehensive standardized insurance packages that have kept administrative expenses down to 7%. They were fortunate to have their system in place before the passage of ERISA and were therefore exempt from its provisions. But even ERISA should not be seen as a barrier to insurance provided by an Authority; most employers may find it advantageous to voluntarily purchase their insurance through the Authority.
Many states already have a private for-profit insurance company controlling over 65% of their state's market. Why not shift that to a non-profit Authority created to do what's best for the public, not maximizing private stockholders' wealth.
The fact is that we can't afford to continue doing the same old thing that is driving up the cost of healthcare from 14.1% of GDP in 2001 to 19.3% in 2009. Dr. John Geyman discusses the "Continued Unrestrained Drivers of Health Care Costs" in his book "Hijacked: The Road to Single Payer in the Aftermath of Stolen Health Care Reform." Those drivers can only be restrained or eliminated now though the use of a state healthcare authority. Only a coordinated holistic approach to providing healthcare between a single financing authority and the community of providers will result in universal quality healthcare at a price we can afford.
There is no reason to wait for the possible enactment of single payer program when we can achieve virtually all of its benefits now through a Public-Benefit Corporation/Authority.