Sally Pipes Sally Pipes (Photo: Pipes)

Advocates of pure single-payer health care proposals for the United States are in a stronger position than ever, and those proposals would create a system much different from Medicare Advantage for all.

Sally Pipes. president of the Pacific Research Institute, has delivered those messages in her new book, “The False Promise of Single-Payer Health Care.” Pipes wrote the book to explain why she believes that the single-payer health care movement is still a contender, and why she believes that shifting to a single-payer health care system would be a disaster.

(Related: Democrats Coalesce Around Health Care)

The Pacific Research Institute is a San Francisco-based think tank that aims to promote the principles of individual freedom and personal responsibility. Pipes has been an advocate of using tools such as health savings accounts and fixed per-person subsidies, or vouchers, to make the U.S. health finance system work better. 

In recent years, Pipes has backed the idea of replacing the current income-based Affordable Care Act premium tax credit subsidy with an age-based subsidy.

Pipes, an economist who grew up in British Columbia, cites the shortages and inefficiencies in British Columbia’s single-payer health care system as a taste of what could happen if the United States moved along a similar path.

Pipes is now giving interviews to support the launch of the new book.

Here are five things she said in a recent interview with ThinkAdvisor Life/Health.

1. The single-payer movement matters.

Sen. Bernie Sanders, the Vermont independent who caucuses with the Democrats, has been introducing single-payer health care bills for years. He introduced the latest version, S. 1804, the Medicare for All Act of 2017 bill, in September.

Rep. Keith Ellison, D-Minn., recently replaced former Rep. John Conyers Jr. as the sponsor of H.R. 676, the Expanded & Improved Medicare for All Act bill.

Voters in Colorado got a chance to vote on a pure single-payer health care in November 2016: They defeated it by a vote of 20% to 80%, even as they voted in favor of Hillary Clinton for president.

Support for other single-payer health care proposals is continuing to grow, in spite of the Colorado ballot measure vote, Pipes said.

Democratic candidates in California are competing to show that they are more enthusiastic than the others about that state’s $400 billion single-payer health care plan, Pipes said.

Single-payer health care proposals will also come up as a major election issue in many other states this year, Pipes said.

“You’ve got a lot of states that are really looking at it,” she said. “it’s definitely a growing movement.”

2. ‘Single-payer health care’ is not the same as Medicare Advantage for all, or traditional Medicare for all plus Medicare supplement insurance for many.

Many health insurers like the Medicare Advantage plan market.

In that market, the government provides a subsidy for all and runs a bidding process for would-be issuers. Private companies get to sell the coverage, and earn solid profits. Agents can earn modest commissions from selling the coverage.

The kinds of single-payer plans proposed in the Ellison and Sanders bills, in the Colorado ballot measure, and in California’s plan would shut out for-profit plans completely, Pipes said.

Pipes said the backers of those proposals could squeeze supplemental health insurance markets even more than British Columbia’s actual single-payer health care system does. British Columbia still has private markets for dental, vision and prescription drug insurance.

The backers of the pure single-payer health care proposals now in play in the United States want their single-payer programs to cover dental care, vision care, prescription drugs, and long-term care.

Pipes does not expect to see British Columbia try to cover dental care, vision care, prescription drugs and long-term care any time soon.

“It’s just too expensive,” Pipes said.

3. Pure single-payer health care could also be different from traditional Medicare for all without Medicare supplement insurance.

 

The Centers for Medicare and Medicaid Services uses private “Medicare administrative contractors,” or MACs, to run the traditional Medicare program.

Today, or example, Wisconsin Physicians Service Insurance Corp., is the MAC for the Medicare region that includes Iowa, Kansas, Missouri and Nebraska. ad for the region that includes Illinois and Wisconsin.

A single-payer advocate like Sanders might shut out the behind-the-scenes administrators as well as the providers of alternative or supplemental plans, Pipes said.

“He really wants the private sector out of it,” Pipes said.

4. America’s Health Insurance Plans needs to bulk up.

Pipes contends that AHIP, a trade group, made a mistake when it went along with Affordable Care Act efforts starting in 2010.

Now, AHIP needs to rebuild its strength and get ready to fight off the single-payer proposals, Pipes said.

5.  Sally Pipes likes to talk to agent groups.

She addressed a group of 500 agents at the end of January and is eager to talk to more. She can be reached through the Pacific Research Institute website.

— Read After PPACA: Sally Pipes Looks Ahead on ThinkAdvisor.

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