Strategy For Transition
A strategy is an integrated set of actions designed to attain a specified and sustainable objective
“A strategy is an integrated set of actions aimed at achieving a clearly defined and sustainable objective”.
The transition to direct-payer will be driven by deciding on the single, identical, comprehensive level of access that will be guaranteed for all Americans from the President to those below the poverty level. The next step in the transition will then be to require all insurers both private and public to provide this level of access as their base plan. This has already been largely specified in the Essential Benefits specified in the Affordable Care Act but should be expanded to cover all necessary medica needs such as dental and long term care. This simple action will force a dramatic downsizing of the private insurance companies and all their clients throughout the economy. This downsizing will be a driven by market forces; a natural consequence of obviating the need for marketing and sales in the insurers and all the organizations and people throughout the healthcare system who deal with them and have to navigate the resulting complexity of the Billing, Reimbursement, and Insurance (BIR)the system. It will also eliminate the need for other middlemen such as Pharmacy Benefit Managers, Preferred Provider Networks and many others that have been spawned to ration health care based on ability to pay. The resulting simplicity and increase in transparency will also create the opportunity systematically reducing costs throughout the system and reducing overutilization and fraud.
Concurrently Medicare would begin the process of absorbing Medicaid and consolidating the public insurers at the federal level. The states would have no role in the federal single-payer system.
Implementing The Strategy For Transition
| Enroll all Americans into Identical No-Choice federally funded single-payer system. Permit optional additional coverage on a self-pay basis | Will drive complexity out of the BIR system. Reduces administrative costs not related to the delivery of care by ~$$600 Billion | No effect on Quality of Care | Phase in over a few years to drive orderly consolidation of the insurance industry |
| Capitalize on transparency of single-payer system to pursue systematic reduction in costs of providing care | Potential to reduce overutilization and fraud by from $300 to $600 | Will improve quality of care by reducing risk of unnecessary procedures and drugs and facilitating delivery of necessary care | Ongoing |
| Eliminate Tax Preference for Employer Sponsored Insurance | Generates ~$300 Billion in new taxes | No effect on Quality of Care | ASAP |
| Eliminate middlemen between Pharmaceutical Companies and Patients | Reduces costs of Pharmaceuticals by at least $150 Billion | ||
| Consolidate all government healthcare insurance agencies into single-payer system | Will improve quality of care to Medicaid patients | Phase in over a few years to endure orderly consolidation of agencies |