The Democratic leadership does not want “Medicare for all” to be the party’s official vision for the American health-care system. Many progressives believe that this is because Team Blue sold its soul to the insurance industry. But what if the Democrats actually oppose single payer because they haven’t sold out enough?
Normally, it would take a family-size portion of hallucinogenic drugs (and/or an especially desperate Slate columnist) to generate such a question. But on Friday, Vox obtained private remarks by Aetna’s CEO that suggest we could bring socialized medicine to the United States — if only the insurance industry exercised more control over our politics.
“In the news media, it is reporting that the Republican health plan is paving the way to a single-payer system,” an Aetna employee asked Aetna CEO Mark Bertolini at a meeting Thursday. “What are your thoughts on that, and how would it impact Aetna?”
Here was Bertolini’s response:
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.
… We’re going to pay for it one way or another. What we have to do is we have to get the costs right. We have to get people healthy. It’s not about who is paying the bill. It’s about what we’re doing to get the costs down. The Democrats are now saying that with the new Republican bill, wait there is nothing in here about getting costs down. That’s the point. And so that’s the place we’re headed as a company. It’s not just about paying the bills.
Okay: This isn’t actually an endorsement of single payer, so much as a strategy for preempting investor freak-out if such a policy were ever to gain steam in D.C.
Still, “we should have a debate as a nation about single payer” is a shade to the left of Nancy Pelosi’s recent comments on the matter. And Bertolini actually makes a worthwhile point about the critical importance of cost control.
As Ezra Klein has long argued, the greatest enemies of socialized medicine in the United States aren’t actually the insurance companies — they’re big pharma, the medical-device industry, and doctors. This is because all of those entities enjoy rates of compensation that would be impossible to sustain if our nation actually guaranteed basic medical services to all of its citizens:
[I]nsurers aren’t where the big profits in the health-care system go. In 2009, Forbes ranked health insurance as the 35th most profitable industry, with an anemic 2.2 percent return on revenue. To understand why the U.S. health-care system is so expensive, you need to travel higher up the Forbes list. The pharmaceutical industry was in third place, with a 19.9 percent return, and the medical products and equipment industry was right behind it, with a 16.3 percent return. Meanwhile, doctors are more likely than members of any other profession to have incomes in the top 1 percent.
… There are few truly single-payer systems in the developed world. Canada has one, as does Taiwan. Most countries rely on many, many insurers. Germany, for instance, has more than 150 “sickness funds.” The Swiss and Dutch health systems look a lot like Obamacare’s health-insurance exchanges. In France, about 90 percent of citizens have supplementary health insurance. Sweden has moved from a single-payer system to one with private insurers. Yet all these countries pay vastly less for drugs, surgeries or doctor visits than Americans do.
Why? Because in every case the government sets prices for health-care services and products. Insurers in Switzerland don’t negotiate drug prizes with Pfizer. The Swiss government simply sets its drug prices and lets Pfizer decide whether to sell in Switzerland – or not.
To be sure: Bertolini’s suggestion that an efficient single-payer system would require the government to partner with Aetna seems dubious. Historically, the use of private contractors has not been an effective means of government cost control. Further, the insurance industry as a whole has not — and will not — be a friend to the movement for “Medicare for all.”
But Bertolini’s remarks are still a useful reminder that insurers aren’t that movement’s only enemy.