This week Poppy Tweets: “At the end of the day, think out of the box!”
In last week’s blog, I reviewed the Healthcare issues you may not be aware of. This week I offer my suggested resolutions.
First of all, no decision maker in the room should knowingly interfere with the natural progression of American Healthcare in Transition:
- Don’t be the victim of hear-say and evidence of that ilk.
- It is like the placebo effect in medical research.
- These data results are false.
- There is an actual hierarchy of proof.
So what should we do to repair this “American Healthcare in Transition”? Here are my suggestions:
1. Remember the confounding variables!
HEALTH CARE COSTS (VARIABILITY)
- Medical Devices and Technology
- Health Care Services
- Patient Compliance
- The Costs involved with NOT being able to afford health care coverage
2. Consider keeping the things about the ACA which make sense. (Like pizza!)
- PRE-existing Condition coverage
- MANDATES FOR insurance coverage
- Offer 10 ESSENTIAL HEALTH BENEFITS in all coverage
- Ambulatory care
- Inpatient Care
- Preventive Services
- Laboratory and X-ray
- Emergency Care
- Mental health Services
- Pediatric Care
- Quality Assurance
- ACCOUNTABLE CARE ORGANIZATIONS
- APPEAL PROCESS
3. Consider another model.
- All modern nations other than the United States publicly administer their health insurance, much like Medicare is administered in the U.S. They are typically accountable on a regional basis and are subject to regular public audits.
- Rather than relying heavily on premiums, copays and deductibles, they are typically financed through their tax structure.
- Every modern nation other than the U.S. has found it feasible to provide these services to all citizens.
- Part of the popularity of Medicare is due to its meeting many of the above criteria: public administration, comprehensiveness, universality, portability, and accessibility.
- A private market has emerged to fill the gaps between those goals and what Medicare actually provides today.
As I see it, we have two choices:
- National Health Service
- National Health Insurance
“National Health Service” forms of single payer typically see physicians directly employed by the national government.
“National Health Insurance” as the nationalization is focused on the insurance functions, not the delivery services. Aligning facilities with the health care needs of the community. They are able to plan in such a way that all insured persons have reasonable access to health care facilities. As a corollary, all physicians and hospitals are provided reasonable compensation for their services.
The new savings from a single payer model would outweigh the new expenses. New annual costs would total $326 billion ($74 billion from normalizing provider payments for Medicaid patients, $110 billion for covering the uninsured, and $142 billion from increased utilization, particularly home health and dental.) New annual savings would total $569 billion ($23 billion in government administration, $153 billion in health insurance administration, $178 billion from increased ability to negotiate the prices of drugs and devices, and $215 billion from administrative cost reductions for providers).
The net savings from a single payer program are thus estimated at $243 billion, covering everyone with better benefits and spending less overall. By shifting from deductibles, coinsurance, and other financial barriers to care to a tax‐based model, 95% of Americans would spend less on health care under this model.
Employers would be able to book reductions in costs and rely upon other reduced
financial risks. In addition to the direct cost of the actual health benefit (8 ‐ 11% of payroll costs) they would no longer provide, benefit administration by itself is complex, expensive (up to 3.2% of current spending) and not necessary under a single payer model. The ever‐growing costs of providing health care to entitled retirees would disappear. There would be concomitant reductions in the cost of Workers Compensation, liability, and automobile insurance.
The sooner we start, the sooner we improve
Single payer does not represent a magical panacea that would cure all of the ills with our nation’s health care system. It does, however, establish an alignment between health outcomes and economic performance. In doing so, it would be the first step in a series of innovations and reforms that would help the United States recover its role as a global leader.