SINGLE PAYER, MEET ALL PAYER: THE SURPRISING STATE THAT IS QUIETLY REVOLUTIONIZING HEALTH CARE
I'am posting the meat&potatoes of this article,because this article is lengthy........
Click the link above to get the full story....
ONE UNHERALDED REASON for Trumpcare’s many difficulties was a sea change in public opinion. A new Associated Press poll finds that 62 percent now agree the federal government has a responsibility to provide health coverage to all Americans, up from 52 percent in March. Republicans looking to take away coverage ran headlong into this wave of support for a bigger governmental role in health care.
“Once you get something for pre-existing conditions, etc., etc. — once you get something, it’s awfully tough to take it away,” President Trump concluded.
There is one state, however, where a combination of fewer institutional barriers and existing health care structures could make health-care-for-all an achievable reality: Maryland.
It will take a grassroots groundswell and electoral victories, especially in next year’s governor’s race. One prominent gubernatorial candidate, former NAACP president Ben Jealous, has ardently endorsed single payer. “We have the opportunity in this state to make sure that we don’t have any more neighbors burying loved ones because they didn’t have access to health care,” Jealous said at an event where Sen. Bernie Sanders endorsed him for governor.
MARYLAND IS THE only state in America where all hospitals must charge the same rate for services to patients, regardless of what insurance they carry. There’s some variance between hospitals, but every patient in a particular hospital pays the same. Other states experience huge, seemingly random differences in hospital costs, depending on the insurer (or lack thereof).
Maryland’s Health Services Cost Review Commission has set hospital reimbursement rates for over 40 years. The state obtained a federal waiver to include Medicaid and Medicare in its all-payer system, with the goal of keeping cost increases below Medicare growth. And it’s worked, creating the lowest rate of growth in hospital costs in America.
In 2014, to prevent hospitals from making up profit margins through volume, Maryland tweaked the system, adding global budgeting. “The traditional way it worked, every hospital got a rate card,” said Joshua Sharfstein, an associate dean at Johns Hopkins’s Bloomberg School of Public Health, and a former head of Maryland’s Health Department. “Now you get a number, which is the total revenue for the year.”
Because the global budget doesn’t change based on the number of admissions, this creates hospital incentives toward better outcomes. “It makes the health system focused on keeping people healthy rather than just treating illnesses,” said Vincent DeMarco, president of the Maryland Citizen’s Health Initiative, a state advocacy group. That includes increased preventive treatment, using case managers to connect patients to primary care, eliminating unnecessary tests, and encouraging good health outside the hospital walls.
Three years into global budgeting, the state is “meeting or exceeding” its goals, according to a January Health Affairs study. Hospital revenue growth is well below counterparts nationwide, or the growth of Maryland’s economy. Plus, state hospitals have saved $429 million for Medicare, more in three years than it targeted for five. Most important, every state hospital (all of which are nonprofit) and every insurer in Maryland are on board with the system.
If a centralized rate-setter bands every insurer together to negotiate prices, all payer can functionally act like single payer in terms of bringing down costs. All payer reduces hospital and insurer overhead, since billing costs are known in advance. And because the Affordable Care Act caps the amountsinsurers can take in as profits, lower hospital costs should flow back to the individual in the form of smaller premiums.
This is why five countries — France, Germany, Japan, Switzerland, and The Netherlands — use all-payer rate setting as the basis for their universal health care systems. These countries have been found to control costs far better than America’s fragmented system.