The underlying dilemma of reforming U.S. health care is that most Americans like their insurance plans. About half the population is covered through group insurance offered by employers, and most are reluctant to overhaul a system that works for them.
Because of that, progressive purists seeking the Democratic presidential nomination should keep an eye on Washington’s budding Cascade Care plan. Our state has become the first to adopt a public option with the goal of increasing the number of citizens who have adequate insurance, the kind that provides preventive care that saves costs in the long run, leads to less self-rationing of doctors’ visits and prescription drugs, and provides an insurance option even in the event of personal financial struggles.
Cascade Care, passed by the Legislature this year and signed by Gov. Jay Inslee, will take effect in 2021 following an enrollment period beginning a year from now. “Washington state is leading the nation in a brighter way to provide for the health and security of our families,” Inslee said at a bill-signing ceremony in May.
Under Cascade Care, the state will offer insurance plans on the Health Benefit Exchange but contract with private insurers to administer those plans. It is a quasi-public metric that critics decry as government intervention in the private market. There are good reasons for caution; on the other hand, the U.S. health care system typically ranks outside the top 20 in the world, indicating the need for improvement. According to the World Health Organization, the United States has by far the most per-capita spending on health care, but we do not have the best health outcomes.
The question of how to foster improvement is at the crux of the discussions. Presidential aspirants Elizabeth Warren and Bernie Sanders, among the leading Democratic candidates, favor a “Medicare for All” system that would provide care for all Americans but would scuttle the private insurance market.