Episode 6: Future of U.S. Health Reform
Stacey and Jake are joined by Professor Bill Hsiao.
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After listening to Episode 6: Future of U.S. Health Reform, we hope listeners have a better understanding of what the future looks like and how the world might change if a Single-Payer healthcare system was implemented in the U.S. Bill attempts to predict the future and shares with listens who will tip the U.S. toward Single Payer and when we might see it happen.
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A summary of Episode 6: Future of U.S. Health Reform and additional learnings can be found down below.
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Thank you for joining us!​
Our Guest
William Hsiao Ph.D.
K.T. Li Research Professor of Economics
Department of Health Policy and Management
Department of Global Health and Population
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William Hsiao is the K.T. Li Research Professor of Economics in Department of Health Policy and Management and Department of Global Health and Population, at Harvard T.H. Chan School of Public Health. He received his Ph.D. in Economics from Harvard University. He is also a fully qualified actuary with extensive experience in private and social insurance. Dr. Hsiao’s health economic and policy research program spans across developed and less developed nations.
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He is a leading global expert in universal health insurance, which he has studied for more than forty years. He has been actively engaged in designing health system reforms and universal health insurance programs for many countries, including the USA, Taiwan, China, Colombia, Poland, Vietnam, Hong Kong, Sweden, Cyprus, Uganda and most recently for Malaysia and South Africa. He also designed a single payer universal insurance model for the state of Vermont which intended to serve as a vanguard for the USA. Vermont passed a law based on his recommendations. However, the recent set-back in Vermont’s economic development has put the implementation of the single-payer system in question.
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To learn more about Professor William Hsiao, please visit the Harvard T.H. Chan Department of Health Policy and Management Faculty page.
Summary
Bill starts this episode off by discussing the feasibility of Medicare For All or another Single Payer System. From our conversation, feasibility seems to rest on two questions: What will I gain and what will it cost? Bill shares that a Kaiser Family Foundation poll showed the nearly 70% of people support Medicare ForAll but that percentage decreases when people are told they will pay higher taxes. As was mentioned, previously, this is a half-truth being spread.
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In the future, Bill believes the public, employers, and physicians will embrace Medicare For All. Employees will continue to want cash wage increases and when this is not possible, they will strike. Similarly, employers will begin to change their perspective as the amount of money spent on healthcare continues to grow and employees become disgruntled. 47% of American physicians are currently paid on salary plus bonus - Bill believes that as this number grows, so will Medicare For All's favorability and likelihood of passage and implementation. He believes physicians spend to much time filling out forms and dealing with insurance companies and that they are tired of the inefficiency.
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Two elections from now you might see more public education of what is Medicare For All and what are the objectives. You will also see the financial burdens on families to be very high. Through his predictive modeling, Hsiao believes that individual Americans will save more than $1,000 per year per person - this includes salary guarantee for two years for displaced workers. The challenge with implementation is deciding on the process and framework - Americans pay for healthcare through state and federal income taxes, sales taxes, premiums, out-of-pocket and through their employers. The financing of Medicare For All would need to be determined - most likely through a tax, which would increase personal taxes but decrease the overall amount of money Americans spend on healthcare. In other words, taxes on middle and upper-income Americans will increase but Americans will no longer pay healthcare premiums and out-of-pocket expense which for some Americans can be greater than $5,000 per person per year.
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Who will pay more? The cross-income subsidization of services is common. The fairest and most equitable way to finance a Single Payer system involves the wealth and more affluent Americans to pay more. This allows for middle-income Americans to pay the safe or less and low-income American's to pay less or nothing. Jumping back to our conversation of social values and ethics and self-motivation - one must consider what they believe in.
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Lastly, Bill is worried about social problems and inequities in the United States. He believes these will only get more and more serious over time, but he is hopeful for the future because of young people.