Friday, June 23, 2006

Single Source versus Single Payer

The posting No Single Payer in Our Time stimulated the below from Bob Sigmond, one of the old lions of health care who dates back to before most people who read this were born and who clearly hasn’t lost anything to the passing years.

I think you are confusing reform based on a single payer with reform based ON A SINGLE SOURCE OF PAYMENT.

In my opinion, a single payer is a very good idea in every community, a relatively simple adjustment in our financing system that would make a great deal of difference. Also, not that hard to make the change. Actually, in many communities, we are moving very close to a single payer WITH MULTIPLE SOURCES OF PAYMENT.

Consider those Blue Plans which are the payer for local subscribers, patients who are beneficiaries of national Blue accounts, Medicaid, Medicare, FEP, and who knows what else. In some places, the Blue Plan is the single payer except for the commercial insurance carriers who would be smart to sign up with the Blue Plan to do their paying obligations [other than to the insured patients directly which is the traditional way that commercial insurers should pay] on a contract basis that would be advantageous to both the insurer and the Blue plan, and would save the insurer a lot of money and headaches, and greatly simplify the life of provider CFO's. Why not?

Now, if the Blue Plan converts to a semi-governmental governance and management structure like a health authority like Gail Warden has created in Wayne County (Michigan), then we have a pattern of a single payer which would have a great deal of ability to influence how the money is spent, while it does what the plan is doing now, and that is administering a lot of different payment arrangements for a lot of different sources of the money.

That was really Walt McNerney's vision when he invented the intermediary relationship for Medicare, which he thought would apply to Medicaid as well, and without the insurers getting involved as intermediary payer competitors in the process, since they had no idea of what that is all about. It did not work out that way, but it could.

Don't give up on single payer just because everyone is confused about what single payer is about: i.e., the payment process. The sources of payment are not so important as how the payment process works, and the lack of a single payer process is probably the main weakness of our system.

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