Single-payer health care can be a budget solution | Juneau Empire

Last week Gov. Bill Walker notified lawmakers that he’ll be calling a fourth special session in October. It’ll focus on new tax proposals to close the budget deficit.

At the same time, he knows reforming health care is part of the long-term solution. That’s why the state is considering a “single entity” insurer concept for current and retired state and local government employees. It could save millions, but not nearly as much as a universal health care program with the federal government as the single payer.

Right now, the state spends almost $1 billion annually on health care for people, their families and retirees of all state agencies, the University of Alaska, local governments, school districts, state corporations. But like the national health care landscape, they’re covered under a dozen different insurance programs.

In 2016, SB 74 mandated that the Department of Administration conduct studies to group them all under a Health Care Authority (HCA). By one estimate, an HCA “has the potential to promote higher-quality care” while reducing costs “on the order of $655 million or 9 percent” from 2018 through 2025.

That $80 million a year average savings is significant. It’s almost as much as the income tax compromise Walker proposed in June.

But an HCA will help only 20 percent of all Alaskans.

Another half has insurance through one of several federal programs, including Medicaid, the military, federal employee plans and Native Alaskans with access to Indian Health Services.

That leaves 30 percent, those who obtain insurance through their private sector employer or are uninsured, to fend for themselves. Could the state afford to include them under one health care plan administered by an HCA?

That’s one question. The other is, since about two-thirds of all Americans already get their insurance through some form government program, why not universal health care with the federal government as the single entity insurer.

The idea is not a liberal tax-and-spend program like it sounds. It’s true the IRS would have to collect higher taxes from us all. But gone would be the insurance premiums we pay, unreasonably high deductibles, and the added costs for going to out-of-network doctors and hospitals.

From a fiscal viewpoint, it would shift the state’s $1 billion annual health care cost to the federal government’s budget. And maybe a state income tax wouldn’t be needed after all.

If we were all covered, the Obamacare employer mandates would be a thing of the past. Instead of wasting time and money stuck between their employees needs and insurance company contracts, small business owners could focus on real work

And there would be no more individual mandate either.

Don’t blame President Obama and the Democrats for that hated provision. And it didn’t come from the Massachusetts health care plan implemented by Mitt Romney when he was their governor. The idea can be traced back to 1989.

“All citizens should be guaranteed universal access to affordable health care,” Stuart Butler explained during a lecture he gave about a Heritage Foundation proposal titled “A National Health System for America”. Among the plan’s key components was a mandate that all households obtain adequate insurance and government subsidies for those who couldn’t afford it.

Why would a conservative think tank known for its advocacy of limited government promote such an idea?

For one, Butler argued that “each household has the obligation, to the extent it is able, to avoid placing demands on society by protecting itself” from potentially catastrophic costs of a serious accident or illness. Otherwise, he said, as we’ve seen for decades, the “more prudent citizens end up paying the tab.”

Without mandates, Heritage recognized America’s health care system was unsustainable. And lurking around the corner was a full-fledged government funded system.

Two decades later, Obamacare’s mandates aren’t working. According to conservative columnist Charles Krauthammer, we’re back to the choices of either “a radically individualist system where the market rules or single payer.” And he added “the country is not gonna go back to” market rule.

Krauthammer predicted America will have a single payer program in seven years. But it could come sooner if Republicans accept his conclusion.

To make sure a national, single payer plan is designed to address Alaska’s unique health care problems, Walker and our congressional delegation should lead this debate. Along the way, they’d be helping to solve Alaska’s long-term budget problems.

• Rich Moniak is a Juneau resident and retired civil engineer with more than 25 years of experience working in the public sector. He contributes a regular column to the Juneau Empire.


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