By NextBestFitBan duplicate private insurance
No private insurance for publicly covered services.
Draft decision:RejectedConfidence: medium · not yet reviewed
Supplemental-only chosen as the middle ground.
Review ledgerHow this path connects
This path
Ban duplicate private insurance
Concrete changes if chosen
What would actually have to change in law, agencies, payment rules, or systems.
- Ban duplicate private insurance for covered services
Effects
Each effect has its own page: the evidence, the case that it is or isn't a real cost, and whom it affects.
What it fixes
- Two-tier care: a private fast lane for those who can pay
Banning private insurance for publicly covered services keeps clinicians in the public system and supports equal care for everyone.
What it creates or worsens
- Longer waits if demand grows faster than capacity
Banning private insurance for publicly covered services leaves patients without a private escape from waits.
12 paths soften this
Legal wait-time guaranteesLonger waits if demand grows faster than capacityChosenBuild capacity before demand risesLonger waits if demand grows faster than capacityChosenPay for activity on top of budgetsLonger waits if demand grows faster than capacityChosenFund more residency slotsPhysician shortage, especially in primary careChosenFull practice authority for NPs, PAs, pharmacists, dental therapistsScope-of-practice limits waste capacityChosenTeam-based care with physician oversightScope-of-practice limits waste capacityRejectedFee-for-service at public fee scheduleU.S. prices are far higher than in other countriesChosenKeep means testing, but expand home careLong-term care requires spending down to povertyChosenAllow private insurance for covered servicesTwo-tier care: a private fast lane for those who can payRejectedBudgets adjust automatically for population, age, and volumeFixed budgets can ration careChosenBase budget plus activity paymentsFixed budgets can ration careChosenWaiting-time guarantees as a backstopFixed budgets can ration careChosen - Faces political, industry, or legal opposition
A ban on private insurance for publicly covered services can face legal challenges, as in Canada.
Who's affected
Who gains
- People relying on publicly funded care
- Two-tier care: a private fast lane for those who can pay: Private fast lanes draw provider time away from public care.
Who loses
- High earners
- Two-tier care: a private fast lane for those who can pay: Paying privately buys faster care.
- Cash-pay and private care practices
- Two-tier care: a private fast lane for those who can pay: They earn revenue from the private fast lane.
- People with employer coverage
- Longer waits if demand grows faster than capacity: They are seen fastest today and would share one queue with everyone.
- People with ongoing or specialist care needs
- Longer waits if demand grows faster than capacity: They need specialists and procedures most often.
Other ways to soften the losses
- Strong wait-time guarantees
Where it has been tried
- Canada (most provinces): Limits on private payment; in Chaoulli (2005) the Supreme Court ruled 4–3 that Quebec's ban on private insurance violated the Quebec Charter, given long waits.
- Canada (Quebec): In Chaoulli (2005), the Supreme Court of Canada ruled 4–3 that Quebec's ban on private insurance for covered care violated the Quebec Charter, given delays where access to a waiting list is not access to care.Sources: Supreme Court of Canada (2005)