Guess who might actually be OK with "Medicare for All" (with one important caveat)?


Nearly two years ago, I noted that the then-CEO of Aetna, Mark Bertolini, gave an unexpected response to to a question about single payer healthcare in a private meeting to Aetna employees:

Single-payer, I think we should have that debate as a nation. But let me remind everybody that Aetna was the first financial intermediary for Medicare. We cut the first check for Medicare in 1965 to Hartford Hospital for $517.57.

The government doesn’t administer anything. The first thing they’ve ever tried to administer in social programs was the ACA, and that didn’t go so well. So the industry has always been the back room for government. If the government wants to pay all the bills, and employers want to stop offering coverage, and we can be there in a public private partnership to do the work we do today with Medicare, and with Medicaid at every state level, we run the Medicaid programs for them, then let’s have that conversation.

But if we want to turn it all over to the government to run, is the government really the right place to run all this stuff? And that’s the debate that needs to be had. They could finance it, and if there is one financer, and you could call that single-payer.

I was instantly reminded of this when I stumbled across this article posted at the National Center for Public Policy Research (a free-market, conservative think tank):


Given an opportunity today to walk back prior support for “Medicare-for-All,” Humana CEO Bruce Broussard refused, effectively making himself an industry outlier. Asked about his responsibility both to shareholders and to those receiving care through Humana, which would be abdicated during a government takeover of health care, Broussard told a representative of the National Center for Public Policy Research’s Free Enterprise Project(FEP) that he considered “Medicare-for-All” a “relative description” and would not comment on legislation widely championed by the left.

...Humana serves approximately 23 million people through its medical and specialty services.

At the Barclay’s Global Healthcare Conference last month, Broussard was quoted calling the “Medicare-for-All” idea a “great opportunity for the industry to be able to expand the population that it’s coordinating care with.

...Broussard’s refusal to engage on “Medicare-for-All” is in sharp contrast with other health care leaders. Earlier this week, United Health Group CEO David Wichmann said “Medicare-for-All” would “destabilize the nation’s health care system” and “surely jeopardize” relationships with patients. Seema Verma, the federal administrator of Medicare, called it the “biggest threat to the American health care system.”

Obviously the Humana article has to be taken with a big grain of salt given the source, but this really cuts to one of the most important philosophical and political issues which will have to be dealt with as the battle for universal healthcare coverage kicks into even higher gear: Just how much of a role, if any, should the private insurance industry continue to have...and how many adversaries are healthcare reform advocates willing to go to war with simultaneously?

The Affordable Care Act was complicated in large part because the Democrats who wrote and passed it learned the lessons of the early Clinton administration: Aside from the fact that "HillaryCare" would have disrupted nearly everyone's current healthcare coverage, if you try to tackle the entire industry at once as well as the entire Republican Party, you're almost certain to lose.

Instead, the ACA had to gingerly navigate through the political minefield. Yes, it eliminated billions of dollars in wasteful overpayments to Medicare providers, and yes it put some important restrictions on the insurance industry like the 80/20 MLR rule and of course the "blue leg" pre-existing condition protections...but it also provided a massive influx of new private policy enrollees and managed Medicaid enrollees, along with heavy financial subsidies to boot.

As a result, the private insurance industry had a sort of wait-and-see approach...they grumbled about a lot of stuff, but mostly held back to see how it played out. Things were ugly and rough for the first few years, but they finally started to calm down and by 2018, most carriers were actually doing fine under the ACA and didn't have much to gripe about.

As for the provider side...well, there were some tweaks and regulations imposed, but for the most part the AMA, AOA, AHA and PhRMA were left alone to mostly keep charging what they charge. And even with all that being hte case, the ACA still barely squeaked through Congress.

Under a Bernie Sanders-style "pure" universal single payer system, the entire private insurance industry would be virtually wiped out (or at least reduced to perhaps 6% of their current size, anyway) while also severely slashing payments to hospitals, doctors, clinics and drug it's no wonder that they've already banded together into a massive new coalition called the "Partnership for America's Health Care Future", which includes AHIP, BCBSA, the AMA, the AHA and other major healthcare industry players:

Even before Democrats finish drafting bills to create a single-payer health care system, the health care and insurance industries have assembled a small army of lobbyists to kill “Medicare for all,” an idea that is mocked publicly but is being greeted privately with increasing seriousness.

Doctors, hospitals, drug companies and insurers are intent on strangling Medicare for all before it advances from an aspirational slogan to a legislative agenda item. They have hired a top lieutenant in Hillary Clinton’s 2016 presidential campaign to spearhead the effort. And their tactics will show Democrats what they are up against as the party drifts to the left on health care.

With this in mind, Broussard's comments (along with Bertolini's statement two years ago, although he's since retired) take on an interesting tone. What it boils down to is this: Health insurance companies don't really care who pays the bills as long as they get their cut. Both men seem to be suggesting that they'd be satisfied with a "Medicare for All"-like system as long as it was managed Medicare...basically "Medicare Advantage for All".

If your primary goal is universal coverage at an affordable price for the enrollee, that might be a viable compromise (the devil would be in the details, of course). If you're dead set on eliminating (or mostly eliminating) the profit-based private insurance industry altogether...probably not so much.