Paduda: Single-Payer Health Insurance and Workers’ Compensation | Workers Compensation News


By Joe Paduda

Friday, June 17, 2022 | 0

Recently, Laura Kersey of the National Council on Compensation Insurance wrote about major legislative trends, one of which was single-payer health insurance. Good research work.

Joe Paduda

First, let’s define “single payer”. By definition, it is government funded and operated health insurance. (Kersey focused on state efforts; for reasons I’ll discuss below, states CANNOT have a single payer).

Single payer is a catch-all term for universal health insurance coverage. In some cases, there is not one payer in a whole country. Our neighbor to the north is an example; Switzerland and Germany are two others.

In Canada, each province is its own single payer; in both European countries, there are a variety of independent companies that provide health coverage. Taiwan has one payer for all residents.

There are MANY different versions of single payer; a discussion is here. Almost every single-payer country is unique, each with its own nuances.

For instance:

  • Most do not have government-employed health care providers. In many single-payer systems, doctors, therapists, hospitals and other providers are private.
  • The UK is an exception; providers are (mainly) employed by the government.
  • Many are not run by the government. In many systems, private insurers contract with the government to handle the administration of health insurance, similar to our health insurance.
  • Again, the UK is an exception.

Typically:

  • Government sets pricing/reimbursement policy and actual prices, like Medicare.
  • Funding comes from a combination of employee, employer and other taxes. In some countries, policyholders pay some form of premium, similar to Medicare.
  • It covers everyone.
  • There is little or no paperwork for patients/consumers; all this is managed by the administrative agency.
  • There are little or no deductibles, co-payments or coinsurance requirements.
  • People can purchase additional insurance from private insurers.

Kersey’s article notes that several states have pending or filed single-payer legislation.

A key issue here is that a very large portion of spending in every state — as in, more than half — comes from the federal government. So unless a state gets waivers from the federal government (which will never happen) exempting Medicare and Medicaid from that state’s single-payer program, most of the medical dollars won’t be in that state’s program. State.

I suggest that how single payer would affect compensation depends on two fundamental issues:

  • Whether treatment for accidents at work/occupational diseases is covered by a single payer.
  • Is there a universal fee schedule?

If WC care is included in the single payer, it is likely that compensation for work would evolve into a compensation only system. This exists in several other countries and seems to work quite well.

If WC medical care is NOT included in single payer, much of the impact would be due to the presence – or absence – of a universal fee schedule.

Without this universal fee schedule, providers would likely continue to maximize revenue, even as they scale up these efforts. Why? Because reimbursement from all other payers would drop significantly, and providers would seek compensation to replace as much of that lost revenue as possible.

What does this mean for you?

There will never be a state-based or state-specific single-payer program.

Joseph Paduda is co-owner of CompPharma, a consulting firm focused on improving pharmacy workers’ compensation programs. This column is republished with her permission from her Managed Care Matters blog.

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