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Ryan King
Noodle Expert Member

January 24, 2020

 These days it seems as though there is virtually nothing that Republicans and Democrats can work together on. Even on big ticket items such as health care – an issue that both parties ack

These days it seems as though there is virtually nothing that Republicans and Democrats can work together on. Even on big ticket items such as health care – an issue that both parties acknowledge needs drastic reform – partisan politics hinders even the slightest whiff of progress.

Back in March, Senate Minority Leader Chuck Schumer said that Democrats would not work with Republicans on anything that would repeal the Affordable Health Care Act. Of course, Republicans won control of Congress and the White House partly because of their commitment to repealing it.

Additionally, Republicans have long expressed their desire to cut regulations, welfare spending on health care, and to defund Planned Parenthood, something that Democrats are diametrically opposed to.

So how could they possibly work together on health care reform?

The first step would be for Republicans to try to defund Planned Parenthood in a separate bill. Defunding Planned Parenthood is a political poison pill that is difficult for Republicans to accomplish with their slim majority in the Senate. Including that in the health care reform bill could deter some Republican senators such as Susan Collins and Lisa Murkowski and potentially foil efforts to circumnavigate a filibuster by Senate Democrats.

As the ruling party, Republicans would then have to offer something that would get enough support from moderate Democrats to get around the Tea Party wing of their party. The would need to get Democrats to break with the leadership and agree to repeal and replace Obamacare. Legislation that creates an all-payer rate setting system might do the trick.

An all-payer system (not to be confused with a single-payer system) would drastically reduce health care costs around the country which would allow for massive cuts in welfare spending on health care, while increasing affordability to millions of Americans. It is something that would satisfy both Republican and Democrat goals in health care reform.

In an all-payer system all private and public insurance agencies unionize and collectively negotiate prices with health care providers. This brings health care costs down because a “union" of insurance companies would have more negotiating power than individual companies have by themselves.

Hospitals in the US currently charge different insurance plans different prices for the same medical procedure. Under an all-payer system, hospitals would only be able to charge one price for a procedure regardless of the insurance plan being used.

Some European countries such as Germany and France use a form of an all-payer system – all of those countries have much cheaper health care than the US. Additionally, one state in the US – Maryland – currently uses that model as well. Their health care costs are lower than the national average.

Under Maryland’s system, an independent state commission known as the Health Services Cost Review Commission (HSCRC), sets the prices. When Maryland implemented the system back in 1976, their health care costs were 26 percent higher than the rest of the country. Today, their costs are 2 percent below the national average.

Republicans in Congress could implement a much more conservative version of an all-payer system at a national level. Rather than having an independent government commission, they could require all insurance companies, including government ones such as Medicare, to unionize and collectively negotiate prices with health care providers for one year.

After that one year, insurance companies could then be allowed to leave the national health insurance union and negotiate with providers by themselves. Considering that the prices they would negotiate by themselves would likely be much higher, it is hard to imagine that any insurance company would want to leave the union afterwards.

This type of system would not cost money to implement and it would drastically save the government and families across America billions of dollars. Given the fact that an all-payer system has not been discussed too frequently in the public sphere, it does not yet  have a lot of partisan opposition.

Obviously, the devil of health care reform is in the details. Some of the other key details of health care reform such as specific regulations and the amount of financial aid for those in need would require significant negotiations and compromises. But if Republicans and Democrats could agree on a serious over-arching structure for health care reform such as an all-payer rate setting system, then maybe they could come together and produce a bipartisan reform package.