Trying to Get Clarification on the Differences Between "Public Option" and "Single Payer"

[Mike 03]

Maybe some DUers like me are having difficulty understanding the distinction between terms like "Single Payer," "Public Option," "Universal Health Care," and "Exchange."

I am still looking for more thorough definitions for some of these, but here is the Wiki entry for Public Option, for what it is worth.

http://www.bloomberg.com/apps/news?pid=20601087&sid=aRXJ.h3tnxOY&pos=2

This definition of the exchange is not very helpful:

http://en.wikipedia.org/wiki/Qualified_Health_Benefit_Plan

What I thought I heard Nancy Pelosi say this morning is that while she had fought for Universal Health Coverage (or was it Single Payer, and if so, are they different?) all her life, she was satisfied that the Exchange would serve the same purpose as the Public Option.

She also said that any insurance company that raises rates between now and the implementation of the Exchange will not be eligible to participate in that program, which sounded good to me at the time.

I don't know enough about this distinction to have an opinion on it, but I welcome help from you all in understanding the differences involved here.

It seems from many of the posts here that this exchange will not cut it. It sounded good to me, but the more I read from you all, the more questions I have.

My excitement is wilting into hopeful apprehension.

[napi21]

1. I can help on some of them.

Universal Health care is providing health coverage for EVERYbODY, similar to what Europe has. There are no copays, no deductibles, and is funded via taxes.

Single Payer and Public Option is very much like Mediare, and you sometimes hear it called "Medicare Parrt E" or Medicare for everyone, but there ARE premiums and copays.

The Exchange is what Congress ha. Health insurance Companies join the exchange and must comply with certain standarars and they are listed for comparison on an "exchange where you can chose the one that best fits your needs. The PO that everyone has been talkin about would be listed on the "Exchange" along with all the ins. co's so they would be in competition with all the others.

[damntexdem]

4. But a PO and single payer are different.

A public OPTION suggests that there would be a public plan that would compete with private plans.

Single payer means that there would be a single, public, insurer, so no competition with private plans.

Medicare for all could be a public option; or could be single payer if no other basic insurance were allowed. In fact, current Medicare is a PO, not single payer, for Medicare enrollees, because of Medicare Advantage, which allows private insurers to insure Medicare enrollees, with Medicare paying them more than the average cost of a Medicare enrollee -- the HCR plan that may emerge would presumably end this extra payment for Advantage plans but retain such plans in Medicare.

One issue is that single payer could be for basic insurance only, with allowance for private add-ons. That is how Medicare is organized now (ignoring Medicare Advantage) -- a basic plan, with Medigap private insurance adding on.

[hlthe2b]

5. I think you are confusing the terms "universal" health care with Naitonalized

health care. All universal health care implies is that everyone is provided some form of payment option that allows universal access to care. It certainly can (and is) accomplished by those countries that elect for nationalized health cares systems (where medical staff, equipment, and facilities are all government run), but can also be accomplished by other blended systems of private and public insurance (which is what is being discussed here).

[hlthe2b]

2. Single payer means all coverage is provided by one entity--

typically the government... That does not mean that the government is providing the health care--only that they are overseeing the payment process. Universal Health Coverage means only that all would have access to insurance and thus access to care from whatever combination of systems that might imply (both private and public coverage conceivably). Public Option, only means that in addition to private insurance, a public entity (for example medicare or a medicare equivalent agency) would provide insurance. Given the lower overheads of medicare, it would be assumed to be far cheaper than private insurance and thus that has the corporate types in a tizzy.

Ironically, Limbaugh's comment that he'd go to Costa Rica just demonstrates how full of shit he is. Costa Rica has a blended system supplying universal health care, one of the best health systems in Latin America. It is based on nationalized health care, but they also offer private insurance. Foreigners living in Costa Rica can join the nationalized system by paying a small monthly fee--based on income--or they can buy health insurance from the state monopoly Instituto de Seguro Nacional (INS), valid with over 200 affiliated doctors, hospitals, labs, and pharmacies in the private sector.

[Spazito]

3. Here is the info I have found describing each...

Single payer:

Single-payer is a term used to describe a type of financing system. It refers to one entity acting as administrator, or “payer.” In the case of health care, a single-payer system would be setup such that one entity—a government run organization—would collect all health care fees, and pay out all health care costs. In the current US system, there are literally tens of thousands of different health care organizations—HMOs, billing agencies, etc. By having so many different payers of health care fees, there is an enormous amount of administrative waste generated in the system. (Just imagine how complex billing must be in a doctor’s office, when each insurance company requires a different form to be completed, has a different billing system, different billing contacts and phone numbers—it’s very confusing.) In a single-payer system, all hospitals, doctors, and other health care providers would bill one entity for their services. This alone reduces administrative waste greatly, and saves money, which can be used to provide care and insurance to those who currently don’t have it.

http://www.pnhp.org/facts/what-is-single-payer

Public Option:

For those who don’t have insurance provided by an employer, or for small businesses who want to buy a plan at an affordable rate, the bills would create a Health Exchange – a one-stop shopping market for health care. Any private insurance company could offer a plan in the Exchange, but they’d have to adhere to certain standards:

There would be a minimum set of benefits for all plans, no one could be turned down on the basis of pre-existing conditions.

There would be guaranteed renewal of policies (no dumping a customer because they got sick.)


You would not be charged a different price because of gender, health status or type of employment.


You would be charged a different rate for age, but it would be more restricted than the Wild West of premium rates today.


If you couldn’t afford the full premium and you made less than 400% of the federal poverty line (about $43,000 for an individual or $88,000 for a family of 4), you’d get a subsidy so your premium would be pegged to a fixed percentage of your income.


Everyone would have a cap on out-of-pocket expenses. And finally,


All of the information and presentation would be transparent -- you would be able to compare standard benefits across companies to find the one that works for you.

http://healthcare.change.org/blog/view/what_is_the_public_option

[Overseas]

6. Medicare for All is most efficient public option. Expanding our existing single payer system.

Medicare = very popular single payer system.
Medical services privately delivered, between you and your doctors.
Payments publicly administered by a single payer, our government, paid for through our taxes and modest co-pays.

Medicare and other single payer systems have such low overhead and high patient satisfaction that they were taken off the table before Democrats even started our healthcare reform discussions because it was felt that the private insurers could never compete with Single Payer efficiency and service levels. Canadians have had single payer for decades now.

Medicare for All is such a clear winner that it was deemed unfair to include it in healthcare reform discussions even after millions of us had been devastated by the Bush Crash and Bush Bailouts.

It might have been inconvenient for our dear Republican friends if the Democrats had gotten millions of us to storm Republican town hall meetings calling out -- "Open Up Medicare! Single Payer Now!"

Medicare could be expanded much more quickly than creating a whole new system. Our Democratic party seemed to have decided that the most efficient effective course for our national health security was less important that getting a chance to engage the other party in exchange for a year of slander.

Naive progressive Democrats like me had hoped that given the emergency situation after the Bush Crash and Bush Bailouts, Democrats would have seized the time to open up Medicare and open up the Congressional insurance exchange to include all of us, democratically, using the majority we gave them in both houses. Expanding both of those existing systems would have meant dramatically improving our national health security much more rapidly.

[Syrinx]

7. single payer == everyone is covered

Single payer means everyone is covered, period. Public option, the federal government runs an insurance plan that anyone, with money, can buy into.

[slipslidingaway]

8. kick and a question - have you been in support of HC reform and

what system did you support?