Warren's Healthcare Plan: One More Thing

In our Commentary of 11/3, we discussed two ways that Senator Warren’s Medicare for All differs from successful programs in France, Germany, and Japan. Today we’ve added a third way that her program is different.

Warren proposes a true single-payer system. While the subject countries provide universal healthcare, they are not single-payer systems. Even our own Medicare program, which remains highly popular in the US, is not a true single-payer system.

In Medicare, participants choose between what is referred to as “original Medicare” (Parts A and B), several private Medicare Advantage Plans (Part C), several private Supplemental Plans, and several private Drug Plans (part D). All plans are regulated and subsidized by the government, but each has its own character and price.

In Germany, health insurance is provided through employers. Germans have nearly 250 different plans to choose from. The plans are provided by nonprofit insurance companies called “sickness funds” that compete for business. Any German can choose any one of the plans regardless of their employer and can keep the plan when they change jobs (or change it at any time).

In France, insurance plans are defined by the government, are based on your geography and profession, and are obtained through your employer. Payments are administered through nonprofit “insurance entities.” If you lose your job, your coverage continues and the government pays the employer’s share.

In Japan, payments are also administered through private providers, of which there are approximately 3,500. Your plan is assigned based on your employment status, and the government provides subsidies to those in need.

As we concluded in our Commentary of 11/3, given the ambitiousness of achieving any form of universal healthcare in the US, perhaps it would be prudent to aspire to a slightly less ambitious program—one that relies on more delivery options than that of a single payer. This is, in essence, the proposal of those who support adding a public option to the ACA.