Introducing the Single Plan for Healthcare
Healthcare proposals are en vogue, and there has never been a better time to think big about what the American healthcare and insurance landscape should look like in an ideal world. Disclaimer: the following is a very rough draft, and more research is certainly necessary before this could be published or presented.

Today we see three big ideas being taken seriously: Medicare-For-All, ACA Reform, and Wild West Care. These ideas roughly follow the partisan divide from left to right, with the former being primarily espoused by Bernie Sanders and his supporters, and the latter being pushed by the Freedom Caucus on the right. Briefly, here are descriptions of each:
Medicare-For-All: Re-make the American healthcare landscape radically by making all citizens eligible for Medicare, regardless of age. Presumably there will be incentives or compulsions to ensure that everyone signs up for Medicare, so as to achieve the goal of 100% coverage. This is both the most ambitious and destabilizing proposal, with big questions surrounding the overall cost and ability of the government to administer such a large program.
ACA Reform: Build off the 2010 ACA law by adding a public option and reform regulations to avoid “death spirals” and keep insurers in the marketplaces. Politically, this is the easiest plan to follow, and it exists alongside Medicaid and Medicare. The problem is that there will still be roughly 20 million uninsured Americans, so it does not count as universal coverage.
Wild West Care: Repeal the 2010 ACA law and repeal regulations surrounding minimum actuarial values for plans, allow insurers to sell across state lines, significantly scale back the size of Medicaid and cap the expansion of Medicare. This plan will lower premiums for most Americans, but will also allow insurers to kick millions off of coverage if they are not profitable. This plan will not achieve universal coverage.
Supporters of each of these plans have valid arguments, however if we are being honest none of these ideas seem particularly innovative, nor do they follow the example of successful programs from other sectors of the US economy. I therefore propose a framework for a new type of law to control the US health insurance industry.
What Americans Want
We first need to agree on what the vast majority of citizens want from their health insurance. The Kaiser Family Foundation conducted a comprehensive survey on this exact topic in December 2016. The main takeaways from the survey is that Americans think that healthcare should be cheaper, which was the top issue for all respondents. The data also shows that Americans are confused by the ACA exchanges and private insurance networks, and therefore prefer the simplicity of Medicare and Medicaid. Finally, Americans want to know that they will be covered in the event of medical emergencies.
Let’s look at how to solve these problems step by step:
- Lower premiums by both increasing the size of the risk pools to include all Americans, and by subsidizing premiums as a percentage of your income.
- Make health insurance simpler to understand by harmonizing all of the different standards across private insurers into one universal definition of coverage, and cover all Americans regardless of preexisting conditions.
- Give Americans piece of mind by mandating that their health insurance covers medical emergencies, doctor visits, common procedures, and preventative care.
Now we are getting somewhere. The three main priorities above are solved by the Medicare-For-All idea, however ACA Reform and Wild West Care do not solve all of these concerns. Medicare-For-All does not account for the increasing cost of the Medicare program and expansion of government administration, nor does the proponents of the plan have a compelling answer for how they will wind-down the enormous private insurance industry in the US without causing massive job loss. However, there is a fourth idea.
The Single Plan
Here are the two unique elements of the Single Plan (S-Plan) idea:
- Instead of hundreds of private insurance plans, and regulations surrounding what needs to be in each plan, we mandate that each insurer must sell a federally-regulated plan, called the S-Plan, if they wish to be a registered health insurance company.
- The S-Plan will be regulated by a body that closely mirrors the Federal Reserve System, in which a Federal S-Plan Board in Washington sets the minimum coverage requirements annually, and the premiums are set by the boards of each 12 S-Plan Districts, mirroring the Federal Reserve District geographic boundaries.
Here is the basic legislative framework for how the S-Plan would be implemented:
- It will be illegal for any company to sell health insurance plans in the United States which do not meet or exceed the standards of the S-Plan.
- All registered providers, hospitals, and networks must accept the S-Plan without exceptions or secondary queues for care.
- All US Citizens will be required to purchase an S-Plan from the provider of their choice. Failure to purchase will result in a tax penalty equal to the exact cost of the S-Plan at their subsidized (or un-subsidized) rate.
- The pre-subsidized premiums for the S-Plan will be identical for all consumers in a district, regardless of age or preexisting conditions. It will not be permitted to sell discounted S-Plans to businesses or organizations, however businesses may subsidize the premiums for their employees.
- The premiums for the S-Plan will vary per each of the 12 geographic districts, and will be set by vote by the S-Plan Board for each district, using data about unemployment, median wages, labor force participation, etc.
- Private Insurers may offer add-on benefits to the S-Plan for an increased premium.
- Subsidies for the S-Plan will be paid for using the existing Medicaid and Medicare funds. Medicaid and Medicare will phase out their own coverage plans as their respective populations will be covered by the S-Plan. The payroll deductions for both programs will continue, and the revenue will be applied to subsidizing S-Plans for the poor and elderly, keeping the core mission of both programs intact.
- The minimum coverage and benefits of the S-Plan will be set by the Federal S-Plan Board on an annual basis, including new procedures and medications.
- The reimbursement for each covered procedure and service will be set by the Federal S-Plan Board annually via negotiation with providers in order to control costs. The reimbursement for prescription medications will be set by the Federal S-Plan Board via negotiation with pharmaceutical representatives.
- Each S-Plan District will administer an online exchange where consumers may compare the providers in their district and purchase an S-Plan, as well as any add-on insurance they may desire.
The end result is universal health insurance coverage for all Americans by compelling them to purchase, at minimum, the S-Plan. Subsidies will ensure that the premiums remain affordable, and by allowing insurers to sell across state lines costs will also be reduced by expanding risk pools. The health insurance industry will become far simpler and easy for everyone to understand, since they know that they just have to purchase an S-Plan to achieve full coverage. Americans will have piece of mind knowing that they are covered in the event of medical emergencies or routine procedures, which will lead to less stress and better productivity across the nation. Finally, the S-Plan system retains the private insurance industry as the delivery mechanism for the S-Plan, which ensures that consumers can still choose their providers and add-on benefits from the private market if they wish. It also keeps government overhead to a minimum since the government does not become a payer, which will help control the budget deficits.
I’ve written this proposal because I am interested in making healthcare both universal and affordable, via a plan which is realistic in our current healthcare environment. I certainly welcome feedback!