A Unique American Solution to Funding Universal Health Care
I support universal health care. But universal health care cannot be offered at “any cost” which is what the progressive Democrats seem to support. Instead it should be provided at far lower cost than health care costs today. Again I don’t mean we should find someone else to pay the health care bill, but real lower costs.
To achieve this goal, there are three major initiatives that our country needs to address and each one separately should produce enough savings to fund an American universal health care system. Taken together they could fund an American universal health care system at a cost competitive with European health care systems today and better quality.
The three initiatives include leveraging the health care system we have today and transforming it into a health care system that Americans will love and support. One that makes its money keeping us healthy and not wasting health care resources. Secondly, addressing the “end of life” moral and ethical issues that have led to huge health care costs that produce little tangible benefits. And third, tapping into the brains of our nation’s best and brightest when it comes to treating obesity through both nutrition, medicine, and exercise.
Some of what I will write fits with what I have written before. But the last two initiatives are issues I have written very little on, because I feel unqualified to answer them and so I raise them, hoping someone that reads this has answers or at least will take up the challenge of developing answers.
We simply pay to much for health care products and services. Not all products and services, Republicans are quick to point out those areas in health care where the “free market” works its magic and drives down prices. But by and large given health care inflation has been much higher than general inflation. It is fair to say pricing is out of control. I support “fair pricing”. In effect, every buyer of health care would be entitled to the same pricing Medicare pays for health care goods and services. Rather than “Medicare for All”, we should have “Medicare Pricing for All”. And Medicare’s job would be to hold down health care prices where the market is failing to do so.
Second, eventually everyone should be under a managed care health plan. We need to avoid unnecessary health care costs so that we have the financial resources to pay for necessary health care costs. The government’s studies show about 30% of health care delivered does not improve the health outcome, reduce pain, or extend life. So then what’s the point. In other instances, necessary health care is not being delivered including preventative health care. Only for profit risk taking entities have the right incentives to want you to live longer and healthier. It is staying healthier and not wasting medical resources where we need to focus the energy of health care risk taking entities. They deserve to profit when they work to make us healthier and when they work to eliminate waste in the health care system, I am less thrilled if they make their profits primarily by paying claims, the government can do that pretty well. Nor do I think risk health insurance companies should profit because they have limited competition through market consolidation or they avoid providing health insurance to people with pre-existing conditions.
End of life health care is a really important matter that our country needs to come to grips with. Experts in medicine, medical ethicists, clergy, and even data analysts need to get together and better identify at what point the health care system can no longer improve health or extend life. Given the tremendous amount of money spent in the last 90 days of life figuring out even a few days sooner than we do today would save billions. People who have never worked in a hospital or health insurance company have not seen the bills that pile up in the last week which produce virtually no measurable impact on the outcome.
Some progress has been made in recent years and some ground lost. Examples of progress include the expansion of hospice and the use of medical directives. But in other cases the elimination of life time caps without the substitution of the ethical clinical parameters to determine when the public will no longer fund health care has caused spending in some areas to increase with no improvement in the quality of life. I won’t pretend to know what all needs to be done. I only know from having been on the “claims end” and clinical end, that it is pretty clear something needs to be done.
Two quick examples, my mother died of cancer. By the time the cancer had spread to her brain, it was pretty clear that her quality of life was declining even as her life was coming to an end. Physicians recommended expensive brain surgery that would not cure her cancer but might delay her death a few weeks as the cancer spread to other vital organs before she died. How does the average family deal with such a difficult decision, yet often ill equipped it becomes the family’s decision. How do we surround the family with the best information available?
A second example, I ran a large physician group (over 400 physicians). Our physicians were organized into “care” groups. One of the functions of these “care” groups was to provide physicians a chance to talk with their fellow physicians prospectively with regard to difficult patient issues. One such case was a person dying of lung cancer, who had already had one lung removed and the cancer had spread to the second lung. The physician responsible for the patient was looking for advice from his fellow physicians as to what to recommend to the family, who was facing the decision of a second surgery to remove a good part of the second lung. This would leave the patient on a ventilator for the remainder of their life which was not expected to be long given the cancer’s presence in other parts of the body.
It took an older physician to tell this younger physician, that the best advice was to tell the family that there comes a time to prepare the patient for their death rather than pursuing life. It runs against the very training of most physicians, who don’t want to give up until a patient dies, but sometimes it is the right action.
We don’t need “death squads” making these decisions, but we do need families equipped with the best information available to make these decisions. Even if families occasionally make the wrong decision (this seems to happen most often when surviving family members have unreconciled issues with the dying member). Nevertheless, I firmly believe with the right information, they will make the right decision most of the time.
Finally, we have the problem of obesity. A Harvard study suggested obesity related diseases account for 30% of the difference between health care spending in this country and in Europe. We are an overweight and sedentary people (by and large) and given all the devices we have, we are becoming more so. For those of you that have watch the animated film Wall-E, it shows a future where we do so little we can barely stand up.
Obesity is a function of so many things ranging from genes, to gut bacteria, to hormone levels, to exercise, diet, mental health, and even income (carbs are cheap). But it is critically important we figure out how to fix this issue. We focus on educating our young and fill them with tons of information, most of which they won’t use as adults, which I am fine with. But we need to do more in the area of health and health training. We need physical education classes that not only provide children exercise but focus on developing in each child a love of “life sports” that they can do throughout life. It would be awesome to see a class “over lunch” where students learn to prepare healthy meals and understand the nutritional needs of their body. They should also develop an detailed understanding of the calories and nutritional value of various foods.
More and more medical interventions are also being developed. Whether procedural or pharmaceutical, the health care system is constantly developing more options to treat obesity. Some of the research in the area of gut bacteria and how it impacts metabolism along with hormonal deficiencies that lead to slow brain feedback on satiation is opening up entirely new ways to treat obesity. But the point is the opportunity to lower health care costs and improve quality of life is huge.
I believe the American universal health system to be affordable needs to start with proper nutritional training as children and intervention where necessary as adults. We need to have the information available to us as consumers and to those we entrust to make critical life and death decisions when we enter the end of life time in our lives. And finally we need a health care system where risk taking entities compete for our “business” by developing cost effective ways to keep us healthy and extend our lives. And purchasers of health care products and services need to be protected from the many competitive barriers that have allowed health care providers to develop pricing power that leads to excessive pricing levels for important life saving products and services.
Funding schemes like Medicare for All is a shame. It makes you think health care is affordable because it shifts the costs to where you don’t see them even if often you are simply paying for them in another way. Like the cost of that new couch that includes the cost of health care for the employees of the company that made the couch and employees of the company that sold you the couch and the cost of healthcare for the employees of the company that delivered the couch to your apartment and the cost of health care for the senior couple they passed as they carried the couch to your apartment. Higher prices for health products and services “creep” into everything we use or buy.
Health care subsidies for those who need them should exist, they need help. But the vast majority of Americans need to know what health care costs are, so they can get mad enough to want change.