Is the US ready for a Single Payer system?

Vitor Pamplona
Jul 23, 2017 · 3 min read

Yes, but there is something even smarter than that.

For an introduction to the topic and the non-partisan way I am taking this, please read Dr. Robert Nevin post. I don’t care if you are a fact-denier (Republican) or a lame (Democrat), we should come together to solve this issue before it’s too late. Health care should not be a partisan issue.

My proposal follows a three legged stool analogy: (i) single payer covers the minimum of all emergency services including medication and treatment; (ii) private payers add comfort layers to such services; and (iii) direct care plans replace insurance services. For (ii) and (iii) patients have time to shop around and use the best of capitalism in their favor.

Let's break it down.

Single payer for emergencies

You don't have time to shop on an emergency. You are required to take and pay whatever comes. That's where capitalism fails, and prices go up. I have long advocated that emergency health care should not allow for-profit companies what-so-ever.

Let's kill the for-profit market for emergencies. Entirely. The government pays for it from our good old taxes. There might be a significant increase in taxes, but hey, you might not need an insurance after all. That should save a healthy young individual at least $400/mo these days.

($400/mo is a lot of money. I am pretty sure even the government is more effective in managing that resource than our insurance companies).

Emergency care is a right to all citizens. Those services come at a higher quality possible, but don't get me wrong, they come at minimum comfort. You will be treated. You will survive. But It might not be a 5-star hotel.

Got money? Pay private add-ons

The middle class and the rich should be able to afford a slightly better room-service at the hospitals or things like medication that does the same but tastes slightly better. They should pay premiums for that. Just like an air-line, such individuals will end up sustaining big part, if not all, of the health care system.

Add-ons should not buy you better care. That's ridiculous. Your chances of survival should not be a matter of money. But it should buy you comfort (I am using comfort a lot — and that’s key). Other than that, feel free to pay to put your Ferrari in the Hospital room so long as that action does not affect any other person.

Direct care plans for preventive care

Capitalism works best when consumers can shop around for the best deals. And that's why our model of insurance fails in the long term.

Direct-care is a new kind of concept where the doctor’s office charges a monthly fee and doesn’t take insurance. It kills the insurance companies and it's becoming common in the US. Even optometrists already offer it. You pay monthly like insurance but directly to the professional that is serving you.

That does wonders to your return on investment.

You can reward the best providers directly with your own cash. Forget about the middle man (insurance). If you want to see a doctor happy: pay in cash. You will become his preferred customer. And best of all? Your doctors don't need to deal with a greedy corporation to get paid. No paperwork. Just your cash. It's like a dream for them.

Also, these days, any clinic can build that model as an app subscription. You pay monthly, you get two visits a year and your questions answered at any time. Maybe it is even more flexible than that. Anyway. It's as simple as visiting your app store and start paying monthly. Think about Netflix for health or Amazon Prime that includes health care.

Let's move the conversation forward

Don't wait for dumb ideas from politicians. They are not the most creative people. If we want a solution, we will need to build it ourselves and get them to pass.

I would love to hear your feedback below. Thanks for reading it!

Vitor Pamplona

Written by

Co-Founder @EyeNetra and SciBr Foundation.

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