In my past four posts, we have examined what our healthcare “system” choices are. To review, they are: the Beveridge National Health Service Model, the Bismarck model, the National Health Insurance model, and the Out-of-Pocket Model.” (1)(2)
What current American model would be the basis for the government sponsored healthcare portion? “’About half think they’ll be able to keep their current insurance,’” says Mollyann Brodie, PhD, Executive Director of Public Opinion and Survey Research at the Kaiser Family Foundation — which is flatly false.” (3) That to me might be the biggest concern facing healthcare consumers moving forward.
Providers and healthcare executives have opinions as well.” NEJM Catalyst Insights Council survey of executives, clinical leaders, and clinicians, nearly half of respondents (49%) identify single-payer as the best outcome for future payment reform. Support is greatest among clinicians (55%), whereas only 39% of health care executives say they want it.” (3)
And the envelope, please.
And the winner is the Bismarck model. This model would allow most consumers to have something in their hands which looks familiar and much like the type of insurance they have today be it employer sponsored or paid for by the government. What overall format would we package it in? This would bring the familiarity to those who currently have Medicaid and Medicare.
In my mind, we might look at the TRICARE program currently in place for our active-duty military and dependents and retirees under the age of 65. This is the model that I advocate. It is a workable single-payor system merged effectively with the private sector. And when the private sector (as well as the government) applied evidence-based medicine to how care is covered, the system worked. The end game was excellent universal ACCESS with improved QUALITY of care at a lower COST. This would be classified as a “National Health Insurance,” as the nationalization is focused on the insurance functions, not the delivery services.
The U.S. Department of Defense (DoD) has made some changes since I exited the role of Corporate Medical Director for a Tricare contractor. And why? COST! To pay for health care for our soldiers, sailors, and airmen, and their dependents as well as retirees under 65 years old, the DoD uses the same pot of money from which it buys guns, tanks and ships. As cost raises for medical care, there is less available for the items of war.
As a result, the DoD has taken local control away from each Service and lodged it in the Defense Health Agency or DHA. “The Defense Health Agency (DHA) is a joint, integrated Combat Support Agency that enables the Army, Navy, and Air Force medical services to provide a medically ready force and ready medical force to Combatant Commands in both peacetime and wartime. The DHA supports the delivery of integrated, affordable, and high-quality health services to Military Health System (MHS) beneficiaries and is responsible for driving greater integration of clinical and business processes across the MHS.” (4)
At the end of the day-the MISSION becomes READINESS AND HEALTH “to deliver the Quadruple Aim: increased readiness, better health, better care, and lower cost.” The Agency Goals:
1. Empower and Care for Our People
- Optimize Operations across the Military Health System
- Co-create Optimal Outcomes for Health, Well-being and Readiness
- Deliver Solutions to Combatant Commands (4)
“What you’re hearing is, this is a Military Health System and not an Air Force or an Army or Navy or even a Defense Health Agency system,” said Lt. Gen. Dorothy Hogg, the Air Force surgeon general. “All the parts are required in order for MHS to be the best it can be. That’s why we’re all committed to making sure transformation is successful.” (5)
As I mentioned above, when a payor system is considered, my preference would be the Bismarck model based on a current ONE-PARTY PAYOR model. The way the DHA/MHS is approaching this needed change could be a lesson to our FOURTH PARTY decision makers as a way forward. Some of the more popular and better-known models being discussed are Medicare-for-all and Medicaid buy-in programs. All options should be on the table during the discussion. The final product should be aligned with the private sector to provide the care in a form fruste of an Accountable Care Organization.
So where do we go from here? Remember the four healthcare models as you listen to the political debate that will rage around healthcare leading up to the 2020 election. We still have to help the SECOND PARTY — you, the healthcare consumer — and the FIRST PARTY — the provider of healthcare — find the best way forward while influencing the decision makers. As our current For-Profit Health Insurance model is broken, and the ACA is under constant attack, there will be a big change for the healthcare insurance industry. Let us work together to make the changes count. Whatever we come up with needs to be a patient-centered medical home. One in which the RETURN ON INVESTMENT is measured in human terms and not capital gains. (2)
Keep an eye out for my soon to be published book: Earthquake: How America’s Ever-changing Healthcare System Victimizes Americans
(1) Chung, Mimi, “HEALTH CARE REFORM: LEARNING FROM OTHER MAJOR HEALTH CARE SYSTEMS,” 2 Dec. 2017, Princeton Public health Review, /pphr.princeton.edu/2017/12/02/unhealthy-health-care-a-cursory-overview-of-major-health-care-systems/
(2) Weisbart, ED MD, CPE, FAAFP, Chair, MO Chapter of Physicians for a National Health Program
(3) Serafini, Marilyn, “Why Clinicians Support Single-Payer — and Who Will Win and Lose,” New England Journal of Medicine, Catalyst, 17 Jan. 2018, atalyst.nejm.org/clinicians-support-single-payer-win-lose/
(4) Health.mil The official website of the Military Health System, Defense Health Agency, www.health.mil/About-MHS/OASDHA/Defense-Health-Agency
(5) Military Health System Communications Office, “Health leaders: Whole of military health is greater than sum of parts,” Health.mil The official website of the Military Health System, Defense Health Agency, 29 Nov. 2018, www.health.mil/News/Articles/2018/11/29/Health-leaders-Whole-of-military-health-is-greater-than-sum-of-parts