"Single payer" usually means HR 676 (unlike other proposals currently making their way through Congress, this bill is only 26 pages long, so its easy to just read the whole thing.)
Under HR 676, the system would be partly funded by eliminating paperwork and the bulk purchase of pharmaceuticals. Additional funding would come from "existing sources of Federal government funding for health care," from a tax on the top 5 percent of wage earners, from a modest payroll tax on workers, and from a small tax on stock and bond transactions. Private insurance companies would be forbidden to sell policies for any of the medically necessary procedures and medicines covered by the system. Patients would be free to choose their own doctors, and doctors would remain privately employed. There would be no deductibles or copays.
The Balanced Choice proposal has several differences.
For one thing, the funding is a bit different. It relies on current state and federal funding, on diverting current employer contributions into a trust fund, and also on what appears to be a payroll tax. The system would be managed by a private non-profit organization rather than by a government agency.
For another thing, patients would make some kind of out-of-pocket payment every time they went to the doctor. There would be two options. Under the copay option, patients would make a small co-pay most times they went to the doctor, and the rest of the payment would come from the system. The payment would be an agreed-upon amount, and the doctor couldn't charge more. Under the independent option, the system would make a basic payment to the doctor, and the patient would pay the difference between what the system provided and what the doctor charged. This would allow wealthy patients to pay more for premium services, and it would allow health care providers to profit by providing those services.
Finally, it seems that rather than having the government negotiate prices for drugs, the Balanced Choice proposal would use a different system that allowed patients, under their doctors' guidance, to choose medication that fit their needs and their budgets. (I'm a bit skeptical about this part of it, actually. It seems like a sop to the pharmaceutical industry, and I doubt it would do much to control costs.)
I think that the Balanced Choice program is an interesting idea. At first glance, it seems that it would do more to more to provide universal care and control costs than any of the plans currently under active consideration in the House and Senate. It would benefit workers, and also employers, who would be freed from the trouble of providing health insurance, and who would be promised cost savings over the current system. As I've noted above, it might make the pharmaceutical industry happy. It probably would make health insurance companies very unhappy, because it would put them out of business.
Furthermore, Balanced Choice is devised and promoted to answer the concerns that conservatives express about the kind of single-payer system envisioned in HR 676.
Providers have justifiably resisted the idea of a government-operated health care system. This is not an abstract ideological position, but one that is based on experience with government systems. Medicare has a history of unilaterally determining reimbursement rates that do not adequately reimburse some areas of health care. In the current system, providers can refuse Medicare patients because there are other sources of income. If there were only one system, it is natural to be concerned about having the profession crippled by misguided government policies. At times Medicare has also made heavy-handed threats of prosecution for fraud and huge fines when providers have made errors in following bureaucratic procedures. The Veterans Administration is known for bureaucratic inefficiency.
Balanced Choice is not this kind of government program. It protects providers from these abuses because it allows patients and providers to make choices. Providers are not locked into accepting the fee schedule and can use the Independent Option if the Copay Option reimbursements are insufficient. Balanced Choice would be required to distinguish between bureaucratic errors and fraudulent billing, and it would be prohibited from the heavy-handed threats of criminal prosecution that were used by Medicare. Balanced Choice is not a health care delivery organization; it is a payment system for independent providers of health care services.
Balanced choice might be a reasonable compromise between conservatives and progressives on the subject of health care. But given that the machinery of both the Democratic and Republican parties seem determined to protect private profit over the public good, I doubt it has much chance of gaining serious consideration.
What do you think?
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