Former New York City Mayor Rudy Giuliani and Howard Dean, MD, former governor of Vermont, sat down with Becker's Hospital Review publisher Scott Becker, JD, Nov. 14 as part of the Becker's 6th annual CEO + CFO roundtable for a freewheeling conversation that covered everything from leadership to fee-for-service medicine.
Though the panelists agreed on most of the evening's topics, they diverged slightly when it came to healthcare. Dr. Dean says abolishing fee-for-service medicine would solve many of the nation's healthcare problems, and believes the U.S. system will eventually resemble something like the Medicare-for-all plan proposed in the Senate in September.
When Mr. Becker asked audience members to raise their hands if they believed in doing away with a fee-for-service system, few hands in the packed auditorium went up. However, Dr. Dean was quick to reassure the audience of healthcare leaders that his vision of the future does not mean the U.S. will adopt a traditional single-payer system.
"It's not going to look like what many people think it will, and it's not going to look like the Canadian system, though I actually think it will be along the lines of Medicare-for-all. Before everyone here despairs, Medicare for all is not a public system; it's a public-private partnership," Dr. Dean said. "You've got Part D, you've got Medicare Advantage, even Medicaid is now run by private companies. So it'll be single payer but it'll be a public-private partnership shaped by providers."
Mr. Giuliani on the other hand, critiqued the tax exemption for employer-sponsored coverage. Though experts across the political spectrum have attacked nearly all aspects of the U.S. healthcare system during the contentious national discourse surrounding the future of healthcare, employer-based coverage is rarely the target of criticism.
However, Mr. Giuliani believes abolishing the employer tax-exemption would increase competition and encourage payers to offer more customer-friendly plans.
"About 110 million people get their healthcare from employers. Just think of what a huge market that would be if people were selecting their healthcare based on what they needed, what they wanted, then insurance companies would reverse their way of thinking about profitability," Mr. Giuliani said. "Profitability would be based on volume. How many customers can I get? Therefore I will design a product that fits my customer."
The employer-sponsored insurance exemption costs the federal government an estimated $260 billion in income and payroll taxes annually, according to the Tax Policy Center, making it the nation's single largest tax expenditure. Though it is costly, 49 percent of Americans are covered through employer-sponsored coverage, suggesting few politicians would consider reforming it for fear of constituent backlash.