Editorial: Gov. Newsom is right: Study 'hybrid' health systems, not just Medicare for All

San Diego Union-Tribune (CA)

There's a fundamental paradox to health care in America. Gallup reported last December that 69% of Americans rate their health coverage as excellent or good and 80% consider the quality of the health care they receive as excellent or good. Yet access to health care and its high cost are such big problems that Democrats have pushed for dramatic changes for more than a decade, enacting the Affordable Care Act in 2010 and calling for "Medicare for All" plans in which government oversees a heavily subsidized system that provides all Americans health care coverage with limited or no out-of-pocket costs.

Further adding to this paradox: However individual Americans feel about their coverage and care, studies have repeatedly found that the U.S. spends far more on health care as a percentage of gross domestic product than other nations yet achieves generally worse outcomes, with a notable exception being treatment of cancer. What's even more stunning is that the U.S. government spends more per capita on health care than nations with single-payer systems like Canada and Great Britain.

Gov. Gavin Newsom, who praised the "Medicare for All" concept last year on the campaign trail, is thankfully offering a more nuanced view now. In announcing the creation of the Healthy California For All Commission, Newsom shrewdly said it would look at ways to expand health care that includes a single-payer government model but also the "hybrid" health systems used around the world. It's not a given that single-payer is best, yet at Thursday night's Democratic presidential debate, it was the center of attention. Former Vice President Joe Biden called it unrealistic. Similarly skeptically, Sen. Amy Klobuchar, D-Minnesota, said it's better to "build a bridge" than "blow one up." But Sens. Bernie Sanders, I-Vermont, and Elizabeth Warren, D-Massachusetts, support different versions of it. Newsom's commission has its work cut out for it because there are so many current plans and because the Affordable Care Act is on increasingly shaky legal ground in part because of changes made by the then-Republican-controlled Congress in 2017.

If America wants to continue with a private health insurance system linked to employment, it could follow the universal multi-payer German model, which costs one-third less than U.S. care. Instead of companies offering a range of policies, workers pay 7.5% of their salary into a national health treasury with a mandatory employer match. They choose among more than 100 nonprofit providers of basic care. This competition creates incentives for providers to offer good care at reasonable costs — incentives not available under single-payer. Individuals who don't want to wait for services such as knee surgery can purchase additional insurance to get quicker access. But in the heavily regulated German insurance market, out-of-pocket medical expenses are limited to 2% of annual income.

Columbia University public health professor Jamie Daw wrote in The New York Times this year that Germany — which became the first nation with a comprehensive health law in 1883 — has been copied far more than Canada or other nations with single-payer systems. It would be a challenge to get U.S. insurers to accept becoming nonprofits subject to heavier regulation, but a solvable one. It would be an easier sell to voters than single-payer. If Newsom's commission gives this option the attention it deserves, that would be a massive public service.

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