Should universal care advocates bite their tongues on single-payer?
“What a single-payer program like H.R. 676 allows you to do is set in place an overall budget,” he said. “If what you’re concerned with is controlling costs, [setting an overall budget] has been shown, here and in other countries, to be by far the most reliable way to do that.”
Remapping Debate asked John Rother, executive vice-president of policy, strategy and international affairs at AARP and the group’s chief lobbyist, whether AARP’s position on single-payer health care had changed since the passage of the ACA.
Rother explained that AARP’s priority was that “everybody should have health insurance, and adequate coverage that’s affordable,” and that the organization is “much more focused on the outcome than the mechanism for achieving that.”
What is AARP?
AARP, Inc. is a 501(c)(4) non-profit, and is the umbrella organization housing several others affiliated groups. AARP, Inc. owns two Limited Liability Companies, called AARP Global Network LLC and AARP Properties LLC. Additionally, it owns the AARP Insurance Plan, which works in tandem with several AARP-sponsored private insurance plans. AARP wholly owns AARP Services, Inc., which in turn wholly owns AARP Financial Inc. Both AARP Services and AARP Financial are for-profit companies, which select and develop services that are then made available to AARP members, including financial services.
AARP also directs two separate 501(c)(3) non-profits, the Legal Council for the Elderly and the AARP Foundation, both of which do charitable work. The AARP Foundation owns the AARP Institute, which is a public policy think tank and also a 501(c)(3) non-profit.
In 2010, AARP and its affiliates had net assets in excess of $700 million, operating revenues of approximately $1.3 billion, and investment income in excess of $125 million.
$679 million of operating revenues came from royalties paid to AARP by private companies for the right to use the AARP name, logo, or mailing list in their advertising. According to AARP’s financial statement in 2010, United Healthcare Corporation accounted for 65% of royalty revenue in 2010 and 2009.
“Single-payer has some advantages,” he went on, “but it also has some disadvantages.” The disadvantages, he said, were that converting to a single-payer model would “disrupt the system that is currently in place” and that “it would require a very significant tax increase.”
Dr. Deborah Richter, the president of Vermont for Single Payer, the chief advocacy group that advanced the single-payer legislation in Vermont, called both of those arguments “disingenuous.”
“To argue that a single-payer system would require a tax increase is to discount the fact that Americans are already paying a huge amount for health care,” she said. In addition to the taxes that are paid into the Medicare and Medicaid programs, she explained, Americans are financing the current system through their insurance premiums, deductibles, and co-pays.
And while it is technically true that converting to a single-payer model would disrupt current insurance coverage, Richter explained that most single-payer bills include provisions that define a “floor” of benefits below which the new system cannot go. The legislation in Vermont contains several of these floors, one of which is the benefit package currently offered by Medicare.
When Remapping Debate asked Rother to respond to these points, he conceded that it would be possible to construct a single-payer model that met AARP’s standards, acknowledging that there were different models of single-payer health care, and that a single-payer framework could be developed to provide benefits that preserve or enhance existing benefit models.
“There are three elements that we consider,” Rother said. “One is benefits, the second is how effective it would be in curbing the rising cost of health care, and the third is how it is financed.” To find an example of a single-payer model that would meet those criteria, Rother went on, “you just need to look across the world to some other countries to see systems that actually function pretty well.”
Affordable care, plus?
The obvious question, then, is why AARP is not supporting the efforts to pass single-payer legislation that are currently percolating. Rother said that AARP’s current priority is to “protecting, to the extent we can, the current Medicare and Medicaid programs,” and to “fully implement the [Affordable Care Act].”
One approach that the organization could take would be to continue the focus on implementing the ACA and on defending Medicare and Medicaid, while at the same time seeking to educate its members about the potential benefits of single-payer health insurance, and even advocating for legislation that goes above and beyond the ACA.
AARP rejects such an approach altogether: “Any criticism of the ACA in the current public debate…would really set back the prospects of successful implementation,” Rother said, adding that advocates who are pressing for single-payer health insurance now are effectively “undercutting” support for health care reform. “I think there are certainly additional steps that need to be taken, but…throwing out additional options could inadvertently support ‘repeal and replace.’”