Government & Healthcare — A partnership that’s too Big to Fail

For years, one of the leading arguments that Healthcare reform proponents have advocated is the need to get Government out of the business of Healthcare. Their basic premise has always rested upon the inability for Government to have a positive impact on the access or quality of care & that Healthcare should be left for the private markets to drive the payor/provider/patient model. On the other side of this argument, are those who advocate for a Single Payor Federal Healthcare system. The basic premise is that Government should and needs to be the provider of resort for those who can’t fit into the private marketplace and should use it’s power to drive down cost, premiums & increase accessible quality care. Between these two pillars of tension, sit the rest of us. We work to improve, address, impact and manage Healthcare in a way that is helpful and positive to the greater audience, but sometimes gets hammered by the polar opposite pillars of strength within the industry. As a former Lobbyist, I can attest that the challenge of Healthcare is unyielding and complex. I believe there is a fundamental fact that both ends and the middle miss in the Healthcare dialogue. The sheer number of Americans who currently receive Healthcare benefits by or through Federal, State and Local Governments. When you see the total number, it brings you to two clear realities:

1. We already live in a single payor model, in which Governmental bodies are the largest payor into the Healthcare Market. So, let it go, you won the first step of your battle. Without winning directly, you are winning 50% of the battle.
2. We must embrace market reforms that can take advantage of the economy of scale that the branches of Government can have as the driver for achieving cost efficiency, access growth and improvement in the delivery and coordination of Healthcare between the Insurer, Payor, Provider & Patient corners of the market. The private sector, by itself, can not sustain a Payor market without Governmental subsidy, spending & involvement. The market reforms you want & need, on the pure free market Healthcare universe, can’t be driven without Government.

In case, for those who believe we can get Government out of Healthcare for a pure free market model and that we don’t have the elements of a single payor national Healthcare system, please look at the following key statistical facts:

181,111,774 — total covered lives through Medicare, Medicaid, CHIP, the ACA, TRICARE-US Military Healthcare, Federal Government employees and dependents, State Government employees and dependents & Local Governmental employees and dependents.

326,647,303 total population in America

55.45% of the USA population receives Healthcare coverage through either the Federal Government, our 50 states governments, US territories & local governmental bodies.

In a nutshell, America is interlocked with Government as a Payor, provider and purchaser of Healthcare goods & services. You have to fix it from within versus trying to dismantle & eliminate it. If you took Government out of the market, not only would our Healthcare markets collapse, 16.7 million jobs in the Healthcare industry, over 784,000 American based businesses and over $3 Trillion in spending would be at significant risk of collapse. Below, I have listed enrollment/covered lives data from the various Governmental market engines who drive Healthcare coverage for over 181 million lives.

57,959,578 receiving health coverage through a Medicare program, as of April 2017 enrollment data from the CMS

74,531,002 individuals were enrolled in Medicaid and The Children’s Health Insurance Program (CHIP) in the 51 states reporting April 2017 data.

• 68,884,085 individuals were enrolled in Medicaid and
• 5,646,917 individuals were enrolled in CHIP. All 50 states, the District of Columbia, and the territories have CHIP plans.

12,216,003 people enrolled in coverage through the federal marketplace (Healthcare.gov) or their state’s marketplace, Health Insurance Marketplaces 2017 Open Enrollment Period Final Enrollment Report: November 1, 2016 — January 31, 2017

• Sign-ups through Healthcare.gov: In Healthcare.gov states, 9.2 million consumers enrolled.
• Sign-ups through state-based marketplaces: 3 million enrolled. In fact, many state-based marketplaces saw increases in enrollment. For example: Massachusetts saw a nearly 20 percent increase and Minnesota saw a 24 percent increase.

8.2 million Federal employees, retirees, and their dependents receive health insurance coverage through the FEHB.

5,281,911 State government employees in 2013 — covered by employer health insurance (compared to 5,331,393 in 2010.)

13,804,380 Local government employees in 2013 — similarly covered by employer health insurance (compared to 14,273,847 in 2010), as reported by the AHRQ 2013 MEPS Survey III.B.1

9,118,900 est. total covered persons — US Military Healthcare Insurance TRICARE Prime, which includes: TRICARE Prime Remote TRICARE Prime Overseas TRICARE Prime Remote