Models of Payment for Universal Health Care

1. Models of Payment for Universal Health Care Scott Tyson, MD

2. Market-Based Model • Insurance based platform, with price control coming from market demands • Continue with multiple insurers or limit total number i.e. Clinton plan • Insurers would create quality affordable products. • Everyone would be required to have an insurance policy. • Funding could be public, private, or both, publicly and privately administered. • The Massachusetts model is the best known example of this.

3. Tax Credits • At present, only businesses can get tax credit for insurance purchases. • All insurance products, regardless of purchaser, would receive a tax credit. • Funding would be public and private, thought actual funding would be through lost dollars rather than actual outlays, privately administered. • There is no real precedent for this on a state level, but HSAs and MSAs are a model of this.

4. Expanded Eligibility for Public Programs • There are requirements for eligibility for most public programs • These would be opened to include say 200, 400% of federal poverty. • There might be increased coverage for certain products through public programs i.e preventative care. • Funding would be primarily publicly funded to expand availability and access, publicly and privately administered. • IL is the closest to this, certainly on a pediatric level.

5. Vouchers • As an extension of the MARKET BASED MODEL, people would be given a voucher to purchase an insurance product. • This could come from the employer, government, payroll, or a combination of these. • All people would receive a voucher to go and purchase an insurance product with the market determining price, availability, etc. • Funding would be public and private, privately administered. • No state model per se, but HSAs and MSAs could be framed under this.

6. Single Payer • All funds would be pooled. • All fees would be paid from a single fund. • The private market would be limited to uncovered services or services that were at least comparable. • Publicly funded, privately administered.

7. Overview of Models • In all of these models, save the single payer system, the premise is the market should be allowed to set prices, compete to help contain costs, and provide the products. • Each uses varying ways of increasing the number of covered lives. • Each is a universal healthcare model, if allowed to expand fully. • Each would involved the private sector to varying degrees as administrating, funding, and dispensing the products.