'3 Employers, 2 Wonks and 1 Health Insurance Mess (LIVE!)' Transcript

May 13, 2021

Note: This transcript has been created with a combination of machine ears and human eyes. There may be small differences between this document and the audio version, which is one of many reasons we encourage you to listen to the episode!

Dan Gorenstein: Today we’re bringing you a special live event that we recorded remotely on May 7. This session was part of a larger conference on health reform in the Biden era hosted by the Leonard Davis Institute of Health Economics at the University of Pennsylvania and United States of Care. 

We’ve edited the recording lightly for length and clarity, and there are a few places where the audio sounds a little “Zoomy.”

We hope the next time we bring you a live event, you’ll hear real audience members clapping, clearing throats, opening chips…and all of the other little things we never realized we could miss so much.

Until then, enjoy this virtual debate about the future of employer-based health insurance.

I’m Dan Gorenstein, and this is Tradeoffs.

So let’s focus on the place that 150 million of us turn to for our health insurance or jobs. Hundred and fifty million is more than 10 times the people insured through Obamacare and double the number on Medicaid. When it comes to the cost of employer insurance, though, premiums for the average family are up 50 percent over the last 10 years. And deductibles are way up, too, in terms of access. Half of all businesses don’t even offer coverage. Today, two policy experts are pitching to very different employer insurance fixes. After that, we’ll get reactions from a panel of employers and bring back our two experts for their thoughts and your questions. 

Okay, our first pitch pre-recorded comes from Penn Law Professor Allison Hoffman. The recipient of that pitch, Stanley Azzuri, is the proud owner of a large racketball manufacturing company played by Tradeoffs’ own Andrew Parrella. The fix Allison’s pitching is a public option for employers. Firms and workers still chip in to cover the cost, but the federal government sets the rules and the payment rates to hospitals and doctors. It’s modeled after Medicare with some tweaks, and it’s optional. But if an employer chooses that plan, it’s the only plan they can offer. Here is the conversation with Allison and Stanley.

Stanley Azzuri: Allison, thanks for coming in today. I’ve just got a few questions for you. So there are a couple of things that really drive me nuts about health insurance plans. The first is cost. I’m a racquetball manufacturer and my premiums bounce around more than these P-57s. So is what you’re proposing going to save me and my employees money?

Allison Hoffman: Stanley, thank you so much for inviting me to meet with you and I hear you. You’re not alone. One of the major pluses of the employer public option is that it would save you money and the hassle of having to worry about health care prices increasing in the future. If today you pay for 85 percent of your employees health care costs, you would do the same under the employer public option. But it would be 85 percent of a smaller number because it would be based on Medicare rates, which are half of what you pay today. Even if the employer public option paid one and a half times Medicare rates, you’d still save money on every item and service that your employees use. And Medicare has controlled health care cost growth, so there wouldn’t be surprises for you in the future. Now, for your employees, it could also cost them considerably less. If you could imagine the ACA style subsidies rolled up into the employer public options, it would mean that some of your lower income employees who have struggled to be able to join your health plan would be able to do so under the employer public option at no cost to you.

SA: Well, that’s some good news for my folks. But the other thing, another thing they’re really concerned about is choice. Every time I make even the smallest change to our health insurance, my workers start sweating more than I do on the court. You know, is their doctor going to be in network, things like that. Allison, what kind of options are my workers going to have?

AH: Stanley, let me first just mention one thing about choice for you, which is that the plan is voluntary for you, which means that if you think it’s good for your business, good for your employees, you can choose it or not. Just like you choose whether to send packages via UPS or FedEx. Now for your employees, we think that it increases choice in the dimension that matters most to them where they can go for care. The employer public option would benefit from Medicare’s vast network, and your employees in turn would benefit as well from the vast network of doctors and hospitals, many of whom they could go to for care.  

SA: Now, Allison, I didn’t start this company 20 years ago to get into the health insurance business. Yet here I am juggling premiums, plans, all the rest. Is what you’re pitching me any simpler? 

AH: Absolutely. You would be freed up from that annual process of having to to look at and compare different choices among health plan options. You would just re-enroll your employees in the employer public option if you’re happy with it. And for your employees as well, they wouldn’t have to wade through this complex maze of health plan choices every year that probably don’t make any sense to them. Also for them it means that if your employees leave the job with you, there are a couple of ways that they could take their health benefits with them. They could take it if there were an individual public option or if they move to another employer who also offers the employer public option, which would make their job transitions simpler over time.

SA: Well, this all sounds great, but I got to say, Allison, no one has ever served me up an ace of a health insurance plan. So what’s a downside that I should be thinking about here? 

AH: Yeah, one downside for you is that you wouldn’t retain control over the details of the plan. I know you’ve worked really hard to customize benefit for your employees. They’re athletic. They want access to the best sports medicine services. And you’ve really provided a fancy plan for them. And they might not get all of that through the employer public option. So you’d have to either manage that transition for them or you could top off the benefits and provide that for them in addition to the employer public option. Either way, over time, we’re pretty confident that your employees and you will love this plan once you get to know it.

SA: Well, you’ve given me a lot to think about today, Allison. Thanks for taking a few minutes. 

AH: Thank you for inviting me.

DG: Okay, so the second pitch comes from economist Brian Blase, a senior research fellow at the Galen Institute and the Foundation for Government Accountability. He’s pitching an idea that already exists in law but is not well known. It’s called the Individual Coverage Health Reimbursement Arrangement, or ICHRA. And that name might be part of why it’s not so well known. Brian helped craft this policy during his time on President Trump’s National Economic Council. With ICHRAs employers set aside a fixed amount of money for workers. Each worker then uses that money to shop on the Obamacare exchanges where they can pick any available plan. Let’s see what Stanley thinks of the ICHRAs.

SA: Brian, thanks for coming in, I appreciate you taking a couple of minutes to chat with me about this. So, look, these health insurance prices, I hate to say it, but they’re kind of a racket. Is this plan going to save me and my employees any money? 

Brian Blase: Hey, Stanley, it’s great to be with you. It’s the number one concern that small business owners have is high and growing health care costs. The individual coverage HRA offers another option for those employers. So it’s voluntary. You only do it if this is best for your employees. And in many parts of the country, this is going to be a good option for your employees. They can get a lower premium health insurance plan, which gives them better value. And you can take the savings from paying less for your workers health insurance and increase their wages and maybe even bring in more workers into your racketball factory.

SA: As I was telling Allison earlier, choice is also a really big deal for my workers. We’ve got a saying around the factory here…sometimes you want the blue one and sometimes you want the green. What kind of options are my people going to have?

BB: You know, the choice of two colors of racketball is more choice than tens of millions of employees have over what type of health insurance they’re going to have for themselves and their families. Nearly three-quarters of employers that offer health insurance only provide their workers with a single type of plan. And think about that, workers are different. We know people have different preferences. They have different preferences over premiums, deductibles, networks, whether they want an HSA. What the individual coverage is, Stanley, it’s the 401k of health insurance. You provide the contribution that is tax free and that worker takes that contribution and uses it to buy the plan that works best for them and their family.

SA: Brian, I got to say, one thing that’s nice about racketball: It’s simple. Either you hit the ball or you don’t. Not so health insurance. I can’t even remember the name of your plan. How complicated is it? 

BB: So it’s the individual coverage health reimbursement arrangement. And for you, it’s much simpler. So you don’t have to get involved with picking the plan. You don’t have to worry about the annual renewal process. You don’t have to worry about many meetings with your H.R. department over how to structure it. You set your budget, you decide which employees you’re going to cover, and you can offer full-time workers and part-time workers different options. You set the contribution amounts and then you hire a vendor. And there’s a lot of vendors that are working with employees so that they can use this individual coverage to pick the plan that works best for them.

SA: Brian, you see this? This is 57 millimeters of perfection, a proprietary blend of polyethylene terephthalate dihydrogen oxide and good old-fashioned vulcanized rubber. I’m sure that your plan is not as flawless, so what am I not going to like about it? 

BB: Well, you know, it’s not as easy as setting up a manufacturing process to produce those racketballs. There’s definitely tradeoffs with offering health insurance in many parts of the country. Premiums are high for individual market plans and those plans don’t cover a lot of hospitals and doctors in those networks. So for workers in those parts of the country, the employers, this might not be the best decision for them yet. The good news is that the individual market is improving. There’s more insurers coming in and I think there’s going to be greater choices over time. But right now, it might not make sense for employers if the individual market is really weak where most of your workers are. 

SA: Well, you’ve given me a lot to think about, Brian, so thanks for coming in.

BB: Thank you, Stanley.

DG: Alright, thanks, Brian. Thanks, Stanley. Unfortunately, Stanley had to run to a racquetball match, so we’re bringing in some real employers to hear what they think of these ideas.

First is Suzanne Delbanco, CEO of the nonprofit Catalyst for Payment Reform that represents large employers like Home Depot, Wal-Mart and other health care purchasers like CalPERS. And then we’ve got Shaundell Newsome, who is the founder of Sumnu Marketing and co-chair of Small Business for America’s Future, and Sheila Savageau, who drives health benefits for General Motors as their U.S. health care leader. 

Shaundell, Sheila, Suzanne, thank you guys so much for taking time to join us today. We’re really excited to have you. We know you’re all very busy. So let’s get into this.

Sheila, we’re going to ask you the first question. When it comes to this idea of an employer public option, a government run plan where the feds set the rules and the reimbursement rates from the larger employer perspective, what’s one big thing you like and one big thing you are not sure about?

Sheila Savageau: Yeah, so the one thing I do like, Dan, is the fact that it’s choice, right. So it’s not a mandate where everybody’s going into it. I think the one thing that I do struggle with is even by having choice in place, you know, as an employer, we take a look at our benefit programs in general and specifically health care, and we take a look at it from a total rewards perspective for recruitment and retention. And so I would tell you, the biggest concern I have is not having the flexibility to actually drive what we want to have within that plan itself. So I think losing that control from the employer’s standpoint is actually the biggest disadvantage in my mind.

DG: And one super quick follow up on that, Sheila, when you talk about that, that that loss of control. Can you just give one example of something that you all at GM are trying to do that really is sort of, in your mind, a push for good for the workers?

SS: Yeah, absolutely, Dan. So if I think about it, we always take a look at health care and we connect it to overall well-being, right? And so when I lose control of that and everything that I think about, whether it’s the diabetic, you know, how do we address them from a pre diabetic phase before they ever get to type one or type two? How does that come into what I call the overall strategy with our wellness program or overall well-being around emotional support, social support, financial support. And so we kind of thread that all together.

And I feel like when you have this what I call choice option, where you’re going to leave things with the one option with Medicare, you kind of lose the advantage of that because it’s not an integrated model at that point. You’ve just broken it apart. And so I think being able to really get the data that we need, really understanding what to call the health of the employee and the dependents themselves is something that we focus on constantly.

DG: Great, thanks, Sheila, appreciate it. Shaundell, when it comes to this idea of the individual coverage HRA, this ICHRA where employers give workers money to go shopping on the Obamacare exchanges, from the small business perspective, what’s one big thing you like and one big thing you are not sure about?

Shaundell Newsome: Well, what I like about it, Dan, is the fact that you do allow the employee to have tax-free coverage, tax-free benefit from the standpoint of their contributions, similar to a 401K. What is tough for small businesses is what they alluded to in the conversation was the cost. At the end of the day, if we keep talking about health care and all these different options, it doesn’t matter if the small business cannot afford it. I mean, we just struggle with cost. And my wife handles our HR, just a small family-owned business. So at the end of the day, it always comes down to costs for us.

DG: And just to try to put a point on that Shaundell, about the cost, can you give us a sense, just a quick anecdote of how cost has sort of squeezed your business?

SN: Sure, Dan, you know, one of the things that people don’t realize about small businesses is we’re always squeezed for profit and depending on your type of business, your profit margins get smaller and smaller. So it’s a matter of how much can we afford to keep going, to even keep the doors open. One of the things that the pandemic did last year was really expose how much cash flow small businesses do not have. You know, most of us have not even a couple of months of reserve.

I mean, I’ve been in business for 15 years, so I’ve gotten a little sharper at it. And because we have consulting services, it’s a little bit different. But I feel bad for the restaurant owners. Like every time you add an additional cost, it just squeezes them and squeezes them out of business. So your favorite little donut shop is getting hammered with more costs every time. So not even so much for me because like I said, well, we have a more flexible system, but I feel bad for those folks that have very, very small margins.

DG: At this point in the event, we had some technical difficulties. So I’ll paraphrase my question to Suzanne Delbanco. 

I asked her if employers are ready to embrace radical changes to their traditional insurance offerings…and if there’s more hunger for that kind of change now than in the past. 

Suzanne Delbanco: Well, I get to work with sort of the cream of the crop who are very aware of the fact that they are spending more and more and not getting more for it. And they’re also aware that how they buy health care impacts the value that they get. So what I would say is that I really love the idea of the employer public option anchoring itself to Medicare prices, because we know that there’s a huge divide between what the commercial market pays and what Medicare pays. And we’ve seen evidence that there is room for ratcheting the commercial payments down. 

My worry is that most employers who try something new or radical like to add it as a choice next to the thing that they’ve been offering all along. And if they’re forced to give up that opportunity, they may say no. I understand why one would want really strong enrollment in this plan, but I’m afraid that might turn some employers off. I think on the flip side, with the ICHRA, that just rolls off the tongue. I think that in certain states like where I live in California, the marketplace is very strong and I would feel very comfortable suggesting to my employees that they get care through Covered California. But for national employers who want to create something that’s sort of common across all their employees, it would be a really tough way to go. I think maybe not every marketplace is as focused on quality as Covered California is.

DG: And, Suzanne, you’ve been in this business of thinking about employers and their thoughts around health care for many years now. Is something changing? Is there a kind of frustration like Shaundell was talking about with prices and I think Sheila alludes to this, too, in wanting to have that control both of what they’re saying can be distilled down to this concern over prices. How is that concern manifesting itself now in 2021?

SD: Yeah, I think the way it’s manifesting itself right now, I think, is in two ways. One is that we’ve hit such a breaking point in terms of the affordability for the average American that we are recognizing that Americans are willing, perhaps for the first time, to make a tradeoff between choice and affordability. So this idea that everybody has to have access to every provider that was talked about positively as part of the employer option, a public option, that’s not necessarily a good thing when you know that some of those providers are poor quality or way overpriced or create excess services so that they can have more revenue. So I think there’s a recognition that employees might be willing to have their choice restricted if it means more affordable care. 

I think the other shift that we’re starting to see is that as decades have passed by, with more consolidation among health care providers and prices rising and continuing to rise, and we now know that prices are the biggest driver of health care cost growth, there is more openness to the idea of government, whether federal, probably more likely state, coming in and trying to make the marketplace more functional with some kind of policy around prices. And most employers shrink at the idea of government intervention, but they’re on an uneven playing field and they’re recognizing that more and more.

DG: That certainly squares with some of the reporting, Suzanne, that we’ve been doing at Tradeoffs this year/ I want to throw that idea, Shaundell, to you and to you, Sheila, and each of you to take a crack at that. Do you find yourselves more open to government involvement now than you were a few years ago? Are you feeling in yourselves a sort of shift? Shaundell, let’s start with you in part because of that amazing jacket.

SN: Thank you very much. So, you know, I am going to say this. It is all about what my employees need. If we were all in when we were told that we were going to get SHOP during the Obama administration we were in, we’re like, OK, cool, we’ll join in. We love this idea. We love this concept. But there always seems to be a glitch or something that gets in the way. One thing we do not like as small business owners is bureaucracy. We don’t want to slow down. We want things to work when it needs to work, make it happen when it needs to happen. And we want the best for our employees. That’s where the challenge is.

SS: Shaundell, I think you said it well. I think if anything, Dan, from my perspective as employers and I think that Suzanne can attest to this, I’m a jumbo employer and I’m out there with my jumbo friends going, “Okay, let’s accelerate this vision on value-based care.” We are not slowing down. We are not waiting. I would say that we are leveraging what we see out of CMMI CMS and some other things, especially around value-based care. I think what we’ve done for far too long is we’ve said, “Okay, employees and family members, you guys decide where you want to go.” I think what we’re seeing is they’re going “You guys know this better than we do.” Where are those high-quality providers? Where are those best cost? Help to direct us. So I would tell you that as employers, we’re accelerating. I’m with you on that. We are not going to slow down. We are not going to wait. 

However, what I do think from a governmental perspective, we’re the same, we’re not here to play politics across the board at all. But I do think it’s important, regardless of what side you’re on, to really inform policy as it’s being developed. You know, here’s what I’ve said about the ACA. The ACA did a tremendous job at really providing coverage for all but I feel like we need to take a step back and there’s a lot of reform that needs to take place in health care before this expansion can take place. I don’t care if it’s ICHRA, I don’t care if it’s public policy. If you don’t have that in place, guys, it’s going to fail. And it is. We’ve got to have reform before we have expansion again. 

DG: I appreciate you. I really want to follow up on this question of evolving thinking. You described yourself as one of the jumbos. Do the jumbos want to see government, the federal government, get involved in a way now that you didn’t really hear from other jumbos five, ten years ago?

SS: I would say I think it’s a little different at least at the tables that I sit around with my jumbo friends. We’ve always said that we can’t slow down, so we’re going to go market by market. I may not have enough presence in certain markets, but I call it phoning a friend…I’ve even reached out to the brokers and the consultants to say, hey, guys, you’re in the small and mid-market but you have volume. I don’t care who you are. I don’t care if you’re a jumbo or not, we really need to make this change.

So do I think that we’re waiting on government? Absolutely not. Do I think that we as an employer community are going to hope the government does some of these things, whether it’s okay, let’s take a look at pricing, let’s take a look at the way quality is being set and have some of these national standards? Absolutely.

And I think as an employer, the other thing that we’re looking for, instead of just pushing along in policy development, come to the employer community. Because Dan, you said it best: 150 million Americans. You’ve got to have the voice of the employer sitting around that table to help influence some of the policy that’s being developed.

DG: When we come back, we’ll pose some audience questions to Allison Hoffman and Brian Blase.


DG: Today, we’re listening back to a special presentation we made last week at a conference hosted by the Leonard Davis Institute of Health Economics at the University of Pennsylvania and United States of Care.  

At this point in the event, we brought back Allison Hoffman and Brian Blase to respond to the employers’ comments about their two ideas. 

DG: Allison, let’s just start with you. Do you have any thoughts or responses to what came up from our employer conversation?

AH:  So I have a number of thoughts, but I want to start by just kind of pulling back the lens and thinking about the fact that we have a larger systemic problem and the employers are one piece of that. So we pay twice as much as poor countries do on health care and we get worse outcomes. We have lower life expectancy, higher infant mortality, worse subjective experiences with the system. And as this past year has shown us, we have an equity problem as well. Some people get the health care they need and others cannot. So historically, the employer piece of the system has been the strongest and it is starting to crumble as well. 

Employers are really struggling. And so the question is, can you start to fix this for employers? Can you start to address some of the problems that they’re facing with escalating prices and also looking 10 years out, create a foundation for a stronger system? So that’s really the goal of what we’re trying to do and to do it in an organic and incremental way, where you put something out there that we know is good. We know Medicare works. So you put something out there based on Medicare for the employers who want they can try it. They can be the kind of the partners with the government to test and see if it works. And if it works, then you roll it out more broadly. 

And at the end of the day, if it works as we anticipate it would, it makes a system that’s better for both the employers because they not only don’t have to manage the escalating health care prices, but they get out from under the regulatory burdens of having to run their own health plan. And it’s better for the employees at the end of the day because they have something that gets them access to good care and they don’t have to go broke from it. So I listen to Sheila and I think, like, she’s a unicorn, right? She’s an innovator. She’s trying to do something great in this space. And not not all employers want to do that, first of all. And even the ones who want to are really having a hard time innovating on their own. We saw that with Haven health care, right? Three of the biggest jumbos, the giants in this space who come together and can’t make it work. And so this is an offering to employers to say here’s something that we think will be really good. Do you want to give it a try and help us? Then work with the government to refine something that might really help employers, help employees and foundationally improve the financing system going forward.

DG: Thanks, Allison, and Brian, do you have any thoughts, reactions first to what some of the employees were saying?

Brian: Yeah, thanks, Dan. I thought the panel was very interesting. It was great to hear their perspective. I do think that some of what Allison is proposing is going to be extremely difficult to get through the political process. So just to start on the individual coverage HRA, it’s been in place for a year and a half. So we worked through political issues. Employers have this option now. And there’s a lot of flexibilities with the individual coverage HRA where employers can start by offering it to, say part-time workers and see how that goes, offer it to just new hires and see how they like it before expanding it to sort of the broader part of their workforce. 

The employer option, it sounds great. Well, let’s just pay Medicare rates and we’ll get lots of savings for that. That’s going to run into a buzzsaw among providers, hospitals, doctors who don’t want to be paid Medicare rates. And there’s also problems with sort of this structure of government setting all the rates. There’s a lot of rigidity, bureaucratic resistance to change, lobbying pressure that comes in with how rates are set. The private sector, when it has flexibility to set rates, they’re going to be able to cover new services. They’re going to be more flexible and innovative with their approaches. Individual market rates right now are somewhere between Medicare rates and sort of where employer group plans are so employers can get more affordable coverage by offering the ICHRA. 

Now we talked about some of the tradeoffs. Traditional group plans are going to have broader provider networks, but the individual market is improving. And this is really a way to increase the simplicity for employers where they’re out of the traditional health insurance game. They’re just setting the contribution for their workers and the workers finally have choice. I mentioned this in the intro, but three quarters of employers that offer plans only provide a single option for their employees. Think about what other major financial purchase that people buy where they only have a single option.

DG: Thanks, Brian and Allison, I’m curious, this is a question that Tradeoffs’ first episode in the fall of 2019 was talking about in part about the public option…I mean, there’s continued to be, at least in some corners of the country, continued sustained interest in the public option. And one of the big challenges, as you know, has been this question around how do you get providers to go along with this? And I know you guys are talking about, you know, paying 150 percent of Medicare rates, [but] as you’ve contemplated and designed this idea, what is it that you think is going to bring providers along, being willing to accept lower reimbursement than they’re currently getting?

AH: Dan, I think that piece that is key here is that we’re on an unsustainable path right now and something is going to happen with escalating health care prices. I mean, providers are enjoying it now. They’re consolidating. The prices will continue to go up post pandemic. We may even see that accelerate. And as we see these trends accelerate, there is more and more pressure to address it in some way. I mean, Suzanne, her work has been thinking about how do you put price controls in the system. And so the key is to offer something where it is a concession on both sides, right? You’re paying somewhat more than Medicare rates so that it’s not kind of wiping out the revenues that the system is enjoying right now. But it is also a reasonable response to this price escalation, which is going to come in one form or another. 

So I think as the writing on that wall gets clearer and clearer, there will be more appetite among the provider community to find something that is a middle ground. I want to say that what Brian was talking about earlier is looking to the individual market as a solution in the space. There’s no reason why you couldn’t use the employer market and set prices similar to where the individual market is, right? So you could have these employer plans paying something less than what they do now and more than Medicare rates, which would be that kind of compromise. So I would never suggest that any kind of health policy reform would be simple because we know anything is contentious in the space. But I think that the key is to find where is the compromise, understanding that reform is going to happen in one way or another.

DG: Thanks, both of you guys. And so let’s try to get in just a couple of audience questions. And so I’m going to ask both of you guys to be brief in your answers. Brian, we’ve got the first question for you. It’s from Tia, thanks Tia. What would you like to see the Biden administration do to improve the health and robustness of the state marketplaces that the ICHRA would send people to?

BB: Great question, and I’m going to start by saying for health policy to be durable, it pays for it to be bipartisan. And the great thing about ICHRAs are Republicans love it because it moves the subsidy, moves the control away from the employer to the worker. And Democrats generally support it because it’s about increasing enrollment in the individual market. So I think steps can be taken to provide some additional improvements to the individual market. Some amount of deregulation could occur, some potentially high risk pool funding where you’re subsidizing the cost to people who are extremely expensive — and right now they are covered in the individual market, that’s one of the reasons that premiums have escalated so high. There’s issues that are very technical around the ACA’s risk adjustment program, which I think could be addressed. There’s potentially ways that you could combine the employer contribution with a government contribution for lower income workers.

Really, I think the option that I’m presenting here is actually more consistent with where the Biden administration is going than what we’re hearing on the public option, like they are right now focused on building on the ACA. And I think there’s a bipartisan way to do this.

DG: Thanks, Brian. Allison, last question to you. Here it is from Ted and Molly. Would there be a role for private insurers in running this public option like there is for Medicare Advantage, or how would this play out in the real world?

AH: It’s a great question, and I think that the ideal solution would be to start off based on traditional Medicare. Roll it out like that. See if it works. Medicare Advantage and private insurers have been testing innovation in the Medicare space for decades now. And the jury is still out on whether they’re offering something that is better than traditional Medicare. So my own personal preference, and obviously this could go any way in the political process, would be to use the piece that we know works to test it. And then if Medicare Advantage and private insurers prove themselves over time, then allow that to be part of the system as well.

DG: Great, thank you, Allison. Thank you, Brian, so much for taking the time to talk to us. We really appreciate it. 

BB: Thank you. 

AH: Thanks, Dan.

DG: And that brings us to the end of our live show. If you want to learn more about the ideas discussed, visit our website tradeoffs.org.

And if you want to hear more about what other employers are doing about the cost of health care, check out our episode from February 18th this year.

I’m Dan Gorenstein. This is Tradeoffs.