The solution to healthcare reform could start with a question you would find in a Political Philosophy course. Is Healthcare a Human Right? Libertarians say it’s not a right, and I understand their argument, although I don’t agree with it. The problem is that health care, in the developed world, has become a defacto right. And retraction of a right is nearly impossible to do peacefully. The only way healthcare can be fixed, without it being a Human Right, is by letting a lot of people die. You would literally have to force ER doctors to not treat dying patients.
Conservatives hate the term Single-Payer Healthcare more than Obamacare, but, the fact is, we have had a single-payer system for many years, it was just a really shitty way of delivering it. Some people had insurance, many people didn’t, but anyone that was sick or dying went to the ER and the doctors and nurses did everything they could to not let the person die. They would then charge the person, when they didn’t get pay, the hospitals would write it off as a loss and all of us single-payers would end up paying for that ER visit. That individual would then go on living their lives; they wouldn’t follow up with their Primary Care Provider, because they didn’t have one; They didn’t fill the prescriptions they were written, because they couldn’t pay for it. And their ailment would just get worse until it was bad enough for the next ER visit.
With a real Single-Payer Healthcare system, those individuals could get preventative care, follow-up care, and medicine, so that those high cost ER visits would decrease. These results have already been seen with Obamacare. This is proactive vs. reactive care. However, Obamacare has a lot of flaws, most of them being the premium and deductible costs for middle-income families, as well as access to providers in less urban areas. There’s a way to fix that, but it would involve a lot of compromise on both sides of the aisle. And although I do not like Trump, he may be the perfect President to accomplish this.
Conservatives argue that this will lead to huge costs because people won’t have a personal investment in what things actually cost, since they aren’t paying for it. They’re right. The solution is make the Single-Payer health insurance a high deductible plan type of plan. Individuals and groups can then chose to purchase options to reduce costs for everything under the deductible. Allow for tax-free Health Savings Accounts, and make the contribution levels really high and broadly regulated to appease Republicans. Encourage private insurers to provide supplemental plans to individuals and groups to manage their costs within the high deductible, and basically buy-down their deductible. And provide income based supplemental plans like Medicare/Medicaid for those that can’t afford to pay such high deductibles or a supplemental plan. This will continue to give an incentive for healthcare carriers to negotiate prices down, and individuals to shop around for care, creating more price competition.
Conservative also argue that private companies run business more efficiently than the government. They don’t want the government screwing up your healthcare. It’s a valid argument. So a solution to this is, have private insurance companies administer the coverage similar to how Flood Insurance works. FEMA doesn’t sell Flood Insurance, Insurance companies do. But FEMA provides the funding for the losses and the administration costs. Single-payer health insurance can work the same way, and will make it easier and more efficient for the private companies to sell coverage to fill in the holes, if you chose to, for the high deducible plans. The insurance company would only have an underwriting risk up to the deductible amount, and the government would cover the costs over the deductible, and they will be paid to administer the plans and act as a private insurer. The NFIP is far from an exemplary paradigm to base a system off of, however, we can use the best practice and worse practices from that program to create a less imperfect system. This is another way to increase price competition on medical products and services. Details would have to be worked out, and it will never be perfect, but it will be a better alternative to government run care, and a much better alternative to no care.
Conservatives argue that socialized medicine has lead to huge wait times and unavailability of care in the countries that have it, which are many. This is a real concern. But there’s a solution to this too, and it helps to solve another current problem, and a far greater, looming crisis. Invest a lot of money, and I mean a lot of money, in training. Take all of our manufacturers, drivers, miners, telephone marketers, cashiers, etc, that are either unemployed, underemployed or will likely be unemployable due to automation; and train and educate them for careers in healthcare. If Universal Healthcare means long lines Capitalist should know that means they have an increased demand, so increase the supply and make money. That will be job creation. And not just crappy jobs, good paying jobs. We’ll need new construction to build the new medical facilities. We’ll need many more doctors, more nurses, more technicians, more custodians, more processors, more teachers and more social workers. So the job openings will be there to be filled. I’m not saying we can turn every taxi driver into a doctor, but they can probably learn CPR and drive the ambulance. Obviously, there will be a gap, and things will never be perfect, but this will eventually solve one problem with another.
A lot of Conservatives point to the VA Hospitals as an example of what will happen to all hospitals if the government gets too involved. I don’t disagree with your assessment, but I disagree that the US cannot solve this problem. For one, the VA health system is a disgrace, and everyone knows it. The worse part is that the politicians could make it better but chose not to because it won’t effect their election results. The VA serves mostly the lower income veterans, so that’s not who’s financing them. If the medical care system was more universal, more constituents would demand improvements. Want to fix the VA? Make it so Congress can only use the VA for their medical care. They’ll start looking for improvements much quicker.
Drug and Medical Equipment prices are a very tricky issue. Marketing is expensive, but cutting out commercials and free lunches for doctors isn’t the panacea (Pun intended). I’m far from an expert on pharmaceuticals and medical devices, but typically, the way that drugs are developed is that research medical schools develop a drug. They then sell it to investors because the regulations from the FDA are too costly and time consuming for the Universities to bare. The investment companies are now taking a gamble on this drug. And their investment really is a gamble, sometimes they’ll spend millions and never get approval, or it could take 10–20 years for the product to hit the market. So in order to encourage investments, they have a certain time period, 20 years, before generics can basically just copy their formula and sell it cheaper. Without that, the investment companies wouldn’t make enough money to offset the losses they sustain during R&D and testing and regulations. Not all drugs are made this way, many are developed in-house at the big and small Pharmas. The small ones typically end up selling to the big ones because they can’t handle the costs and time either. The big ones take the same gamble as the investors, so they have to be mindful of not overdeveloping to much and having too much money going out and not enough coming in. This process is why drugs are so expensive, and why there isn’t a lot of development of drugs that aren’t going to make a lot of money. It’s also why drug companies charge so much. Maybe it only costs $1 to actually make your blood pressure medicine, but they charge you a few hundred. It’s not just to line the pockets of the executives, it’s also to pay for all the drugs they tried to get to market that failed, and the costs of R&D for 15 years of testing before they could deliver it to you.
So, here’s a solution, cut out the middle men. Give more money to the Medical research universities, subsidize the testing and regulation costs, and then encourage the Universities themselves to sell the drugs and medical devices. This will boost the prestige of the Universities, and create a reputation risk of them charging to much. Capitalism. GlaxoSmithKline isn’t really effected by losing goodwill over a price increase, but Stanford and Johns Hopkins would be. Their reputation is very important to them, so developing new drugs, with their name on it, will boost that, and help keep them in line for pricing. And the investors that buy the rights to these drugs are doing so as an investment. Their only goal is making as much money as they can. They aren’t the ones making the drugs themselves, the scientists and doctors do that. And the scientists and doctors will still get paid well, but they are typically not in their professions to make obscene profits, that’s the goal of investors. Lastly on drugs and devices, we must also demand favor nation status in drug pricing in exchange for these tax subsidies.
There are many reforms that are needed to for the medical industry, and I’m not smart enough to have solutions for these. An institutional problem is frivolous litigation. On the other hand, if a doctor is negligent, there should be a way to compensate the patient and limit the ability for that doctor to practice if it happens a few times. However, it should be noted that the numbers amounts of paid malpractice claims have decreased about 40% over the last 15 years, and that increase is greatest in cases in which the payouts are less than $500,000.
Anecdotally, I know many personal injury attorneys in Florida that are very wary of taking a Medical Malpractice case and will only do so in circumstances of gross, obvious negligence. This is not to say that frivolous lawsuits are not an issue. Claims have gone down for a variety of reasons, including State tort reforms, more conservative jurists being on the bench, and many physicians choosing to go without Malpractice Insurance.
So, it is an issue that needs to be addressed as well. The fear of lawsuits causes doctors to practice too much defensive medicine. They do costly, unnecessary tests and procedures, for the purpose of saying they did it in case they get sued.
Another major issue is the high costs of prolonging life. So much money is spent on adding a few extra months to the end of an elderly person’s life. If you had to chose between 6 more months with Grandmom, or 4 years of college for your kids, you know what you would chose, but no one wants to let their grandmother die. So I don’t know how to fix this, but we need a plan as the boomers get closer to reaching this age. Should a 95 year old really be able to get a $100,000 triple bypass? My grandfather did. It worked. He lived a couple of more years, and I’m happy he did, but that doesn’t mean it was the right thing. There’s probably billions of dollars of other changes that could be done, but like any industry, the medical industry suffers from it’s resistance to change.
Most Americans don’t realize that we spend more tax dollars on healthcare than any other country, despite those countries having Universal Healthcare, and us not covering millions of Americans. Additionally, that tax spending has decreased, not increased, under the ACA.
A major reason for this is that our healthcare industry obscenely overcharges us for everything. One of the top arguments of conservatives against Universal Healthcare is that prices will get out of control unless patients take responsibility for the costs, but that wasn’t the case pre-Obamacare and that’s not the case in the countries that do have Universal Care.
Now many Conservatives might argue, we pay more but we get better healthcare. That’s wrong. We have the highest per capita healthcare expenditures in the world, but we’re 37th in Life Expectancy. So we pay way more, for much less.
So where’s the money going? Our physicians make more than physicians in other countries, but that gap is not astronomical, and is almost non-existent when you factor in that their student debt is basically non-existent.
These numbers need to be studied by independent economist, to figure out where the money is really going and how to reduce costs. The payment amounts to the hospitals and physicians need to be determined and agreed upon, based on compromise by both sides, and reworked constantly to insure solvency, and competition. There’s a balance that can be achieved between providing enough incentive for hospitals to continue to improve to attract patients to them versus other hospitals, and controlling government spending. That part will not be easy; who knew Healthcare was so complicated?
If you still believe in American Exceptionalism, than you should also believe that we have the ability to provide Universal Healthcare better than the other countries that do it. Some of their systems are good, some are bad, but none of those other countries have the American spirit and ingenuity which has made us the greatest Nation this planet has ever seen. They also don’t have the per capita GDP output we have. The American Medical Community is the best in the world, and no one living in the United States should not be able to utilize because of its price. Access to care, is a BS term. I have access to a boat, but I won’t die without a boat, so I’m ok with everyone not getting a boat. Healthcare is different. Call it whatever you want, Universal Healthcare, Socialized Medicine, Single-Payer, CommieCare, even Trumpcare, I really don’t care, but it’s the only real solution for 21st Century America. We have socialized police, socialized fire departments, socialized highways, socialized militaries, socialized libraries, socialized education, and none of them are perfect, buts time for imperfect Universal Healthcare. #Healthcare #Singlepayer #UniversalHealthcare