Thread by @Skoldylox

THREAD on distinctions between the phrases "#unifiedfinancing" and #singlepayer, in the context of #CalCare and #SB770. TL;DR, the phrase "unified financing" is the new "access to coverage" and we need to dispense with it for good 👇👇👇

1) I have some thoughts about the phrases "#unifiedfinancing" and "#singlepayer." Some people use them interchangeably, but they should not. They are distinct, and those differences really matter.

2) "#singlepayer" is a specific policy. It is a health care system where payment for all essential health services are delivered by one entity, one single payer, for a given population. There are no middlemen, no insurance companies, no ACOs, just one single, public plan

3) "#unifiedfinancing" on the other hand, simply means that the funding for a given health care system starts from a single source. It does NOT necessarily mean that that source is the ultimate payer for health services. Multipayer systems can have unified financing

4) Why does this matter? Let's look at some of the debate about the direction of #Medicare.

All health care dollars that are used to pay out claims to Medicare beneficiaries start in the Medicare trust fund. This by definition makes Medicare a system of #unifiedfinancing

5) However #Medicare is NOT #singlepayer. Medicare Part C (#MedicareAdvantage) is a program where private insurance companies receive Medicare dollars to provide coverage to seniors. This would be impossible under single payer, where there can only be one payer for services

6) On top of #MedicareAdvantage, there is also the widely-discussed #ACOREACH. This is where people who are a part of traditional (non-Advantage) #Medicare are still being treated by doctors that are a part of an ACO (basically a doctor group acting as an insurer)

7) This means that the ultimate payment for services is not done by #Medicare, it's done by these ACOs. Even though the money starts in the Medicare trust fund, it is funneled through other payers. Not #singlepayer.

8) So basically, #Medicare is #unifiedfinancing, but not #singlepayer. And that distinction matters, because the parts of Medicare that are fragmented have WAY higher operating costs, administrative overhead, and instances of fraud than traditional Medicare.

9) This makes sense because fragmentation is the major reason why our health care system is so absurdly expensive. Fragmentation can, and does, still exist even under systems of #unifiedfinancing that lack a #singlepayer. Unified financing does not necessarily mean single payer.

10) To make this point even further, let's take a look at the two competing proposals in California on this subject: #CalCare and #SB770. Two proposals that do very different things, that are in direct competition with each other, despite the proponent efforts to claim otherwise

11) #CalCare is a proposal by @CalNurses to guarantee health care to all Californians by way of a #singlepayer health care system. There is no ambiguity as to what CalCare will accomplish, the phrase "single payer" is in the leg summary and the policy as was outlined in #AB1400

@CalNurses 12) #SB770 on the other hand , is not a health care proposal. It is functionally a study bill, a call for informal conversations between California and HHS over what a system of unified financing might look like. I've outlined some other objections to that bill in a prior thread

@CalNurses 13) What I didn't discuss in that thread, however, is that nowhere in the leg summary or the policy language of what #SB770 does is the phrase "#singlepayer" used, with one minor exception. Instead they use the phrase "#unifiedfinancing" throughout.

@CalNurses 14) The phrase "#singlepayer" is used in #SB770 twice (three times if you count "new single, government-administered funding system")

One of those times is talking about existing law, not SB 770.

One of those times is a leg finding about the HCFA Commission, not SB 770

@CalNurses 15) The only time the phrase "#singlepayer" is used in actionable text of #SB770 is a fleeting mention in the context of calling for discussion about a just transition for health care workers. Nothing about the core functions of this study bill, those are all "#unifiedfinancing"

@CalNurses 16) This is the same thing the HCFA commission did. It called for a report on options to reach a system of #unifiedfinancing "including, but not limited to, a #singlepayer system." Even the commission that #SB770 would be duplicating the work of, acknowledged the distinction

@CalNurses 17) And that's the rub...the HCFA commission report included a lot of discussion about #unifiedfinancing with middlemen, but only a small amount of discussion about #singlepayer. Which is exactly why this distinction matters. Proponents claim this is a single payer bill. It's not

@CalNurses 18) To be frank, when proponents of something constantly say "#unifiedfinancing" i don't trust them. It's the new "access to care" in my opinion. It's a cop-out. It's a way to advocate for half measures. A system of unified financing that allows fragmentation to continue to exist

@CalNurses 19) A system of #unifiedfinancing that allows fragmentation to continue to exist will not achieve the cost savings or the universality that a #singlepayer system would. We should not settle for an inferior policy. There is no benefit to settling for less than true single payer

@CalNurses 20) There are some proponents of health care reform that believe otherwise. They think you can continue to allow entities like Kaiser to exist as insurers and have the system be as effective as #singlepayer.

I disagree with those people, and I think that position is harmful.

@CalNurses 21) We need guaranteed health care for all. #Singlepayer is how we get there. #MedicareForAll is how we get there. #CalCare is how we get there. Half measures like #SB770 and ACO loopholes will not get us there. There is no policy or political benefit to settling.