In our current landscape we’ve got an insurance/banking regulator in every state, plus DC and Puerto Rico. Then there’s the US DOL, that regulates self-funded employer plans (ERISA). Then there are local, state, and federal employee/retiree plans. Then Medicare and Medicaid, which fall under CMS. Finally there’s the wild west of plans offered by religious employers, which aren’t under the jurisdiction of any administrative agency (if you exhaust your internal appeals your only recourse is the courts). This state of affairs is largely due to the McCarran-Ferguson Act, which asserted that insurance was the exclusive jurisdiction of the states (in response to a SCOTUS decision that said otherwise). So we’re left with an insanely inefficient patchwork in which large insurance companies shop for jurisdictions that make it as easy as possible for them, and as opaque as possible for customers. I think if we simplified regulation of insurance, we’d have less of a pressing need for single payer.
In our current landscape we’ve got an insurance/banking regulator in every state, plus DC and Puerto Rico. Then there’s the US DOL, that regulates self-funded employer plans (ERISA). Then there are local, state, and federal employee/retiree plans. Then Medicare and Medicaid, which fall under CMS. Finally there’s the wild west of plans offered by religious employers, which aren’t under the jurisdiction of any administrative agency (if you exhaust your internal appeals your only recourse is the courts). This state of affairs is largely due to the McCarran-Ferguson Act, which asserted that insurance was the exclusive jurisdiction of the states (in response to a SCOTUS decision that said otherwise). So we’re left with an insanely inefficient patchwork in which large insurance companies shop for jurisdictions that make it as easy as possible for them, and as opaque as possible for customers. I think if we simplified regulation of insurance, we’d have less of a pressing need for single payer.