Some people have advocated a 'single-payer' system. Why has it not gained more support?
Single payer is a health system run entirely by the government. It would
replace the private insurance market, creating a Medicare-like structure that would cover all Americans.
The government, the single insurer, would pay hospitals and doctors for their
services. The idea has not gained traction, despite passionate advocacy,
because of widespread opposition to government-controlled health care and to
dismantling the current system. "It's not politically feasible,'' says Donald
Taylor, a Duke University health policy professor.
Would reform require individuals to buy health insurance?
It's very likely. People from low to middle incomes would receive subsidies
to afford it. Medicaid, a government program for the poor and disabled, could
be expanded to cover more lower-income people. The goal: drastically reduce the
number of uninsured Americans, currently at 45 million. Meanwhile, people who
get insurance through their employer would likely retain that coverage.
Would reform require employers, including small businesses, to cover their workers?
Despite opposition from the business community, a plan that requires
businesses to provide insurance benefits for their employees likely will be
included. That could mean that companies with more than 25 employees (or
possibly 50) would have to provide insurance for their workers or pay a
penalty. Smaller businesses would be exempted. The House bill unveiled Tuesday
would exempt firms with a payroll of less than $250,000 a year. Wal-Mart's
recent endorsement of such an employer mandate ''made a huge difference on this
issue,'' increasing chances of this provision passing, says Karen Davis,
president of the Commonwealth Fund.
What is the most controversial aspect of the Democrats' reform overhaul?
Democrats are pushing for a public plan, run by the government, to compete
with private health insurers. President Obama says it would ''keep insurance
companies honest.'' Individuals and small businesses could shop for an
affordable plan in an insurance ''exchange'' or marketplace, which would offer
different choices. But Republicans feel a public plan eventually would drive
health insurers out of business and leave a health system run entirely by the
government. This could be the issue that blows up a potential agreement, says
Paul Ginsburg, president of the Center for Studying Health System Change.