Almost everyone agrees that health care in USAmerica is broken and too expensive. Our costs are higher than other developed nations but our outcomes no better. In some cases they are worse. But how do we fix it?
Not everyone agrees on the solutions - especially insurance companies, big Pharma and Republicans. They continually attempt to dismantle the advances of Obamacare and blindly trust private markets, whether or not they can offer improvement.
Even those who understand markets will never reliably provide these essential services efficiently, there remains much disagreement.
Some say Medicare for all, period, single payer, universal coverage.
Some want to enhance Obamacare, keep expanding the “pool” and rely on better market regulations.
Some would continue to rely on private markets but possibly provide a public option.
So who’s right? Ever wonder why single payer, universal health care costs less? Where are the savings?
The first 20-25% comes from streamlined administration. There is one plan and one form. Avoiding myriad company plans, groups, requirements, restrictions, forms, approvals and denials makes administration much easier and less expensive. Maintaining the myriad makes these savings unattainable.
The second 15-20% derives from negotiating as THE group. Embedding a public option within myriad private plans to compete for beneficial rates diminishes this negotiating advantage. A public plan might get something, but certainly much less.
The last big chunk of savings, another 15-20%, comes from preventative, long-term care. We’ve seen that the current system has no incentive for preventative care. That’s why many outcomes are worse and the fight over pre-existing conditions continues. The myriad plans and companies save money by denying services and coverage, shifting the problem between companies or plans until costs eventually land on the general rate base as uncompensated care, and everyone’s rates go up. It’s the ‘costs plus’ model of ‘doing business.’ Obamacare improved this somewhat, especially for the wholly subsidized, but it has not been effective at controlling or reducing costs system wide.
Only universal coverage plans can achieve these savings. There are different ways to accomplish this. England uses fully socialized medicine, a completely public single-payer plan with the government in charge of everything and costs covered by taxes. Canada uses a National Health model utilizing many private providers but all paid through the government, mostly covered by taxes (but including modest premiums in a few provinces). These single-payer plans have the lowest costs.
Some countries, like Germany, have universal, mandatory coverage in a multi-payer system using a combination of taxes, employer contributions and private plans and premiums. But, over time the German public has moved almost entirely toward the public plan with only about 11% currently opting for private insurance.
Regardless, the key element common to all is that they are not for profit. Every other developed nation on the planet has disposed of the misery money medical machine that profits from individual suffering. Single-payer, universal coverage achieves the greatest savings and will produce better outcomes.
The biggest problem for USAmerica is that we have a mish-mash of all these systems AND most are designed to turn a profit. Veterans get a socialized plan like the Brits. It’s not for profit but doesn’t reliably attract the best and brightest. Medicare recipients get something like Canadians but must rely on doctors’ medicare quotas for primary physician care within the private markets, and can still get stuck with devastating bills. Many corporate employees enjoy an employer participation plan like the Germans but constantly struggle to negotiate affordable rates - which only a few dwindling labor unions can leverage. Then, a huge number pay out of pocket - if they can. If not, they dump their costs on the public, or die, or are driven homeless, adding other public costs. This is sometimes referred to as the Somalian Plan.
Adopting ONE system will be required for any savings. Getting rid of profit based markets will be required to achieve control. Only a robust public health context for medicine can achieve the best long-term care and fiscal benefits. Medicare for all is our best choice - a universal, single-payer system. If options are unavoidable, make sure it is a comprehensive public plan with a private option - not the other way around.
Estimated at $3.3 trillion in 2016, and rising more rapidly than any other economic sector, saving half our medical expenditures will make trillions of dollars available for other things in our lives and the economy, possibly helping to solve other critical issues around housing, elder care or climate change - or anything actually productive. The present system is wasteful of money, time, and lives.
I will be on the lookout for candidates who understand how to better keep citizens healthy AND save money doing it. That means universal, single-payer coverage - Medicare for all.