"On our current track, health care is anticipated to consume 20 percent of our GDP at about $7 trillion annually. Cost containment is key to making the system affordable, and many options would provide relief while at same time enhancing the quality of health care delivery."
Bruce Van Zee, M.D.
I requested guest posts from people with knowledge and experience in healthcare delivery.
Yesterday I posted the first response. Today I post another.
Bruce Van Zee is a retired nephrologist. He lives in Medford, Oregon and calls himself a "Never Trumper." He began sharing his thoughts during this second Trump term in his new blog on Substack.
Guest Post by Bruce Van Zee, M.D.
I read the yesterday's guest post by Mark Knudsen, and dashed off a comment. I wanted to add to the discussion of what we might do to fix health care in the USA. Other developed countries have worked out a way to have access to healthcare for citizens. We know it can be done because it is being done.
Rather than reiterate what I have posted on health care in the past, I will leave links to several of the posts at the end of this comment. I agree with Peter that the system Mark described could well improve the chaos and dysfunction that now permeates our system, but it is complicated and still has too many moving parts, I think. Currently, our providers ---hospitals and physicians -- are inundated with regulations, forms, requests, and criteria from a host of payers. They must hire large numbers of clerical people to deal with all the players, each taking a bite out of the health care dollar that ideally would be going to care. It is no wonder the American hodgepodge system is twice as expensive than all other Western developed countries and delivers worse population-level outcomes. To add insult to injury, it still doesn't provide universal access, even in Oregon, which has a robust Medicaid system, the Oregon Health Plan.
Imagine if our federal highway interstate system had been built by individual entrepreneurs to their own specifications for signage, asphalt, maintenance, and so forth. And with a toll booth every 25 miles or so. I'm a believer in free enterprise and capitalism; government should not be involved in selling cars or TV's. But neither should for-profit businesses, private equity, and publicly held companies be major players in health care. Shareholder goals are not the same as what patients need. When Obamacare was being debated, we almost got a Medicare option for all. If that had happened, our problem might be considerably improved. Medicare runs with a 4 percent overhead. Private insurance and for profit companies are above 20 percent. Denials and prior authorization are not significant issues with traditional Medicare because they are only based on scientific evidence of benefit, not the conflict of interest in profit vs. care that for-profit companies face. Former Governor John Kitzhaber's program more than a decade ago for Oregon Medicaid was rational. Care was ranked: A special health commission ranked hundreds of medical conditions and treatments based on clinical effectiveness and public values. That is a much more appropriate way to manage costs than denial of care based on profitability.
Bottom line: my vote is for a Medicare-for-all option. The obstacle in doing this is, of course, the monied interests that are immense, all taking a bite of the $15.5 trillion being spent on our dysfunctional health care system. And those players give enormous amounts of money to the lawmaker's campaigns to make sure the system doesn't change. It will take a grassroots effort to convince legislators to offer a Medicare-for-all option. The beauty of the option is that you don't have to do anything with the for-profit companies; they will be unable to profit as they have been as folks begin to realize the hassle-free value of traditional Medicare. The costs of the increased Medicare system will require higher corporate and high-income taxes, but businesses would be relieved of the burden of employee health insurance.
I have been posting my own thoughts on healthcare at my Substack site: https://bvzcvz.substack.com.
Here are links to specific articles:
Can we afford medicare for all?
Traditional Medicare vs Medicare Advantage?
U.S. healthcare costs and outcomes: a primer
4 comments:
Many doctors will not accept Medicare because the payments are too low. If Medicare for all is implemented with that same level of payments, there is likely to be a massive wave of physician retirements, which will result in a huge deficit of medical services. Wait times for everything will balloon.
I can hear the commercials already: we now have socialized medicine; how do you like socialism now?
The current system is not good; something needs to change. But someone much smarter politically than I am will need to figure out how to navigate the change so that that it won’th won’t produce a catastrophic backlash.
I was raised with socialized medicine – in the U.S. Air Force. It works great. In addition to providing medical care for all, we should be providing education for all. If doctors didn’t graduate so high in debt, they wouldn’t need such high incomes. Also, there would be more of them. Also, getting rid of the insurance middlemen would mean more healthcare dollars to spend on actual care.
None of the other countries have gone back to what we have and our life expectancy is less for a reason. Bring on socialism if that includes everyone having government medical care.
Remember, Scandinavia is not socialist. The Scandinavian countries are capitalist social democracies.
Be careful and precise about what you wish for. The history of socialism is grim. Would you want to live in: the Soviet Union, Communist China, Cuba, or Venezuela under Chavez and Maduro?
Me either…
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