Health-Care Reform: Progression From a Government Run Public Option to a Universal Single Payer Health-Care System–By the Numbers (US Population)

Health-Care Reform: Progression From a Government Run Public Option to a Universal Single Payer Health-Care System – By the Numbers (Analysis of the US Population).*

What will be required for the federal government to take control of health-care in the US? A majority stake in US health-care is the answer. The proposed government run public option (GoRPO) is the first step in the process. This is the only possible conclusion upon analysis of health insurance data later combined with the GoRPO.

The US Census Bureau considers four major categories for Americans with health insurance: Medicare, Medicaid (includes the State Children’s Health Insurance Program; SCHIP), employment based (private) health insurance (includes the Federal Employee Health Benefits Program [FEHBP] and Tricare [covers active duty personnel, retirees and their dependants]) and self-pay. In addition to Medicare and Medicaid, the federal government is also responsible for insuring veterans (VHA) and Native Americans (IHA). Insurance data from the US Census Bureau show that 111 million Americans have their health-care insured and managed by the federal government (Medicare, Medicaid, VHA, IHA), about 33% (see Figure 1). [Note: The US Census Bureau realizes that many individuals with Medicare also have other insurance, but such data are not available).

Though not managed directly by the federal government, the health insurance coverage for Tricare beneficiaries and participants in the FEHBP (approximately 9 million Americans in each of these groups for a total of 18 million insured) is actually paid for by the federal government. Since the government is responsible for paying the health insurance for these individuals, the federal government in effect controls their health-care because the government negotiates with the entities to manage the health-care of those enrolled in either Tricare or the FEHBP. That is, the health-care of those enrolled in Tricare and the FEHP is de facto government run health-care. Rather than account for these 18 million individuals under the employer based (private) health insurance category, it would be more appropriate to include them as a government program (along with Medicare, Medicaid, VHA and IHA). Consequently, this now brings the total number of Americans whose health-insurance is controlled by the federal government to 129 million, an increase to 38% (see Figure 2).

Regardless of the veracity of the number of uninsured considered to be 47 million by the administration and much of congress, we will use this number as it seems to prevail in many discussions and speeches. If we now insure the 47 million presently uninsured in the GoRPO, this brings the total number of Americans whose health-insurance is controlled by the federal government to 176 million, an increase to 46% (see Figure 3).

Now let’s suppose, not an unrealistic supposition at that, that about 10 million individuals (21% or approximately one-fifth) who pay for their own insurance (the self-pay category) realize they are eligible to participate in the GoRPO [a rather conservative estimate, actually]…. and they elect to participate. This now brings the total number of Americans whose health-insurance is controlled by the federal government to 186 million, an increase to 49% (see Figure 4).

Some have predicted, and I think correctly so, that many businesses will find it far less expensive to pay a fee to the federal government than to cover their employee’s health insurance. Let’s make a conservative estimate (guess, if you will) that of the 159 million presently receiving employer based insurance, 20 million (or about 13%) find themselves seeking and receiving health insurance through the GoRPO. This now brings the total number of Americans whose health-insurance is controlled by the federal government to 206 million, an increase to 54%; that is, more than half of the US population (see Figure 5).

With the government providing for the health insurance of over 50% of the population, it would be the major health-care stakeholder in the US. Such control would, without question, directly lead to (A) terms dictating how health-care is managed in the US, (B) [initially] a two tiered health-insurance system, and (C) [eventually] a single-payer universal health care system. That GoRPO is the first step leading us toward a single-payer universal health care system is appreciated by REP Anthony Weiner D-NY who supports such a health-care system for the US. Given the example of Medicare and in an effort to control costs, health-care rationing on a fiscal basis is only a matter of time. (See my essay titled: Health-Care Rationing - A Practical Construct).

*Abbreviations in Figures:
GoRPO – Government Run Public Option
FEHBP – Federal Employees Health Benefits Program
IHA – Indian Health Affairs
VHA – Veterans Health Administration

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