Recently, I followed Twitter links down an ideological rabbit hole, until I found myself reading a health policy blog on a conspiracy theory site. The gist was that mainstream columnists are bashing the practicality of Bernie Sanders’ health system change proposals, without taking the time to look at the details, because creepy entities have paid them off.
On the one hand, my first instinct was to post a link to my article, based on Sanders’ new health policy proposal summary and the text of the American Health Security Act (AHSA) bills he’s introduced, which, in my opinion, is pretty granular. The Berniecare article may not be a path-breaking work of investigative artistry, but it’s comparable to my article about Ben Carson’s health system change proposal.
On the other hand, I decided that trying to post a link to one of my articles on the conspiracy theory site, or even naming it here, might not be the safest thing to do.
Maybe I’d get stalked, or hacked. Or, worse: If the so-called conspiracy theory site is just a cold, calculating effort to bring in unique visitors and enhance visitor engagement, I could get trapped in endless efforts to defend an open-minded approach to health policy with a clever robot that’s designed to get other people riled up.
On the third hand, I think a serious problem with many health policy discussions is that the people involved fail to define terms like “Medicare for all” or “single-payer health care system.”
One well-known single-payer advocacy group, the Physicians for a National Health Plan, defines a single-payer system as a system in which one public or quasi-public agency organizes all health care financing but (conveniently enough for physicians) leaves the delivery of care largely in private hands. That group says the single-payer entity should cover all medically necessary services, including dental care, vision care and long-term care, without charging co-payments or using deductibles.
Sanders himself says he wants to provide Medicare for all, but his AHSA bills would eliminate the current Medicare program. His bills would also eliminate the Medicare supplement insurance market, by prohibiting AHSA system health care providers from imposing out-of-pocket fees on patients.
If ordinary voters hear Sanders talk about providing Medicare for all, some may think he means allowing the sale of Medicare Advantage plans.
Other voters may recognize that Sanders dislikes the Medicare Advantage program, but they may think he wants to provide something like the current traditional Medicare program for all. Psst! Here’s a secret about the current traditional Medicare program: Private contractors administer it.
Maybe Sanders has a proposal for privatizing U.S. information technology companies in the works. Assuming that he does not have such a plan, the health care payer business would still be a huge business even if the government brings Medicare administration in-house.
Unless we have a pure government-run economy, the government would hire the same kinds of companies to build and run its AHSA IT systems that private health insurers now use to build and run their systems.
Health insurers and health plan administrators might not play a major role in Sanders’ AHSA system, but the same IT vendors making a fortune off of health care IT work today could make an even bigger fortune doing AHSA IT work. The IT vendors would sit at the top of the health care administration contracting food chain. They would no longer have to split health plan administration money with the insurers.
If conspiracy-minded supporters of single-payer health care systems speculate that nefarious health insurers and IT companies are behind opposition to single-payer health care proposals, maybe opponents of the proposals could come up with conspiracy theories of their own that involve IT companies with a hankering for big, cushy AHSA administration system contracts.
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