How serious are Americans about a single-payer health care system?

Heating up

In California, single-payer health care will continue to be a major issue. I anticipate the election of a very pro-single-payer governor and insurance commissioner in November, and they will likely push for a statewide single-payer system. While I don't think this is a viable debate at the policy level (tax increases and federal waivers will be stopping points), it will be a huge debate at the political level for the next few years.

I think single-payer proponents will get more traction at the national level, because we already have a public/private program, Medicare, that is functioning relatively well and can be expanded incrementally to include more people.

Related: Can a single-payer health system work in the U.S.?

I am adjusting by adding Medicare to the list of services my agency offers. The market is strong, the carriers are stable, the commissions are solid and the need is there. Adaptability is key in this ever-changing space!

Amy Evans, president, Colibri Insurance Services

A seat at the table

If—and it's a big if—we end up with single-payer, I would hope it would look like a combination of public and private entities like Medicare Parts A and B (public) plus a supplement (private). I can't see businesses allowing the loss of an important tool to recruit and retain talent, as well as the elimination of a significant expense that translates to a formidable business tax write off.

I think we're still a long way off. While it makes great talking points and excites the base, consider the current environment. Implementing something of this magnitude will never get done as long as the lack of bipartisanship in Washington continues.

If there seems to be a legitimate effort underway to create a single-payer program, it's imperative that agents and benefit consultants have a seat at the table. We have to work shoulder to shoulder with influential business leaders and organizations to make single-payer right for the stakeholders, not someone's re-election campaign.

Helena Ruffin, president, Ruffin Insurance Solutions, Inc.

A balanced view

The single-payer model has positives and negatives. On the positive side, providers would stop discriminating against patients on the basis of their insurance, as there would no longer be different rates of payment for a single service. Health care coverage would presumably be universal, so no one would have to go without care or risk being bankrupted by care. The single-payer would have great leverage to negotiate reduced prices for care (including Rx) and businesses would be able to take health care line items out of their budgets.

Negatives would include the cost. Also, wait times would likely go up, as many more people would gain access to care, but there wouldn't be an increase in providers. In fact, there very well may be an exodus of providers, given they would no longer be able to set their own rates but would instead presumably have to receive payments the government decided on. It would also likely decrease innovation in many sectors that would no longer be able to compete for better profits.

Alex Lickerman, MD, founder and CEO, ImagineMD

New opportunities

Single-payer in the next decade? It's possible, but it would be a complex, costly and difficult transition. The executive branch has had significant influence on health policy during the last decade and I believe that trend will continue.

If/when the executive branch flips to a Democrat, the likelihood of a single-payer system will increase. Legislators are tied to states, and states have their own ideas and protectionist tendencies. We will continue to see states dabble in health care along party lines, but the federal government will move with the executive branch on health care policy. Moving to a single-payer system would accelerate the impact that policy has had on the benefits marketplace. Even 2019 open enrollment is fluid due to the decisions that employers are making with regard to the individual mandate.

Single-payer would not be a death sentence for the industry, but it would be a significant change. With change comes opportunity. The products and services we offer will change, but employers will still be looking for non-compensation incentives to offer employees. In my opinion, the institution of a single-payer system would likely create a dual market in our country. Every citizen would have access to a base plan for coverage, but people employed by large employers, in competitive job markets, or in white-collar markets would likely be provided significant supplemental plans. That presents opportunities for the benefits marketplace.

A transition to single-payer would be more painful for other industries within health care than it will be for the benefits brokers. Hospitals/providers, pharma, medical device manufacturers and government agencies will all experience significant disruptions. Brokers took a good dose of medicine as ACA was introduced and rolled out. Complexity rose while compensation went down, which reinforced our ability to identify opportunities, adjust and adapt to change. Our market could get smaller, but providing benefits people value will still be an opportunity. Our business will continue to progress in new and exciting ways.

Brian Robertson, executive vice president, Fringe Benefits Group

Northern perspectives

Opinions from an ex-Canadian: While I'd like to say there's a slim chance it could happen, recent polls say I should treat it as a more serious possibility. The biggest surprise to voters would be to learn how other countries run with lower costs when organized through a single-payer monopoly:

• Choices of what's covered under the plan are made for them

• Choices of where they want surgeries are made for them

• Wait times for tests and surgeries skyrocket

How would our company respond? Today, we combine practical tools that help people control their health care dime, time and peace of mind. If single-payer was passed, there would be more things not covered and new needs to solve, so we'd continue to innovate and grow.

Reid Rasmussen, co-founder & CEO, freshbenies

Complexity & expertise

I believe massive change to the health care system is inevitable. It has become increasingly publicized that our system isn't stable; I see this as a time to have a positive impact on the future. No matter what shapes our health care system takes, complexity assures the need for expertise.

The information easily available to the public is confusing, and typically misleading, with inaccurate or incomplete details. We live it day in and day out; even our doctors need agent expertise to understand the nuances of financing health care.

This is a big part of why I'm passionate about the NAHU Education Foundation and the re-invigorated CAHU Foundation. If we can work harder at informing the public about ways to use our system more cost effectively, we can help drive costs down with consumerism which drives competition.

People want affordable and easy—that's what they think the many terms to describe “single payer.” The stress of the whole process, much less understanding their choice, has them fed up. That's saying nothing of the ever-increasing premiums.

Agents are overwhelmed by the need to restructure their business models to adapt to the changes in our market. This is a thrilling time for those who see the opportunity in disruption. It's increasingly clear the new generation of agents are wanting more than a “price, benefit and cost comparison.” They want to address the issues. They are getting creative by and creating packages for clients using alternative solutions such as referenced-based pricing, HRAs and other new ideas.

I see a bright future for agents who want it. We can't predict the future, but we can create a diverse business plan that doesn't depend solely on things not in our control.

Dawn McFarland, president, M&M Benefit Solutions

Still on the fence about single-payer? Read up:

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• States where single-payer health care could work
• Health agents fight single-payer storm with tornado