Aetna CEO Threatened Obamacare Pullout If Feds Opposed Humana Merger

Anyone who thinks this is leading to single-payer is dreaming. Whether you think it's a good idea or not, the political will wasn't there for in 6 years ago, and there is much less political will for it now.

Then at least Aetna will twist in the wind for their avarice.

By walking away from the exchanges they are just walking away from a money losing business. That isn't twisting in the wind.

The ACA established programs to make payments to insurance companies that got unusually expensive customers but the funding for those payments has been blocked.

http://www.modernhealthcare.com/article/20160517/NEWS/160519...

The issue with those blocked payments is that the program was established to deal with an uneven distribution of unusually expensive customers. Insurance Company A makes more than expected so it pays into the pool. Company B loses more than expected so it draws from the pool. Thinks were expected to even out overall.

But what has happened is that all (or most) companies are losing money on the exchanges so there is no one to pay into the pool. Congressional Republicans have blocked funding the pool with government money because the pool wasn't supposed to cost money in the first place.

The most likely outcome is a public option in the exchanges. I don't expect that many private insurers will continue to participate in the exchanges if they have to compete with a public option, so the public option will end up being a de-facto single-payer system for poor people who have to use the exchanges.

The public option isn't supposed to be government supported. It's run by the government, but with a private budget, taking all their operating fees from users. A lot of people on the right are skeptical that it will become either de jure or de facto government supported, and comments like "I don't expect that many private insurers will continue to participate in the exchanges if they have to compete with a public option" are the reason.

I'm skeptical of that the public option will work as well as its proponents say it will. We already have non-profit health insurance companies, and they haven't completely eaten everyone else's lunch. But it's worth a shot, as long as it really truly sticks to that mandate of not being government supported. The argument would need to be really convincing given how many of its backers think it ought to be government supported any way.

Walking away has to be a fundamental right.

There's a lot more political will for a "public option" now (largely because the people who have said it wasn't necessary in the ACA-style setup and that private insurers -- augmented by the coops that the ACA created a framework for -- would step up have increasingly been proven wrong.) Whether a public option is a step on the road to single payer depends on a number of things, including how private insurers respond.

The coops have not been doing well. https://www.washingtonpost.com/national/health-science/12-bi...

A proper public option receives no more government support than a private company does. If answering to political pressure instead of answering to a board of directors turns out to be an amazing thing for health care efficiency, single-payer could be on its way. I think that's dreaming by people who have never run anything in their life, but I also think that they should be free to try and fail, as long as it's a genuine same-as-a-private-company public option.

When you want something to happen politically, you need to work from a position of strength. If you have had a bunch of failures recently, people will not trust whatever new promises you are making. (And saying the failures were someone else's fault is the worst excuse of all. It's not like all those people you blame the problems on have died.)