by Larry Oxenham, Publisher
CONTEMPLATIONS OF LIFE IN AMERICA, Part II, Healthcare of All …
There are many elements of life in America that need to be addressed today but the one that rises to the top seems is universal access to health care, more commonly referred to as FREE healthcare for all. (And, by the way, everyone in America already has access to health care through any emergency room anywhere ….)
We believe a universal plan – probably a single payer plan – will come, and socialized medicine will be our future.
Healthcare for all is a nice goal. It may even be a realistic goal.
But you can’t, as president Obama did, lock three radically ideological individuals in a room, give them free reign to design what they want, and then carve out exceptions for the unions and many companies that donated to you, in addition to offering prime pickings to assure profit for insurance companies and then call it the Affordable Care Act. It was neither affordable nor caring.
A solution is essential because the ACA, according to a major insurance provider, is in it’s ‘death spiral’.
It is often said a camel is a horse designed by a committee; the ACA is a camel.
One essential mistake made with the ACA was the promise that health care could be provided for all and not only save money but be free to many people.
UNIVERSAL HEALTH CARE CAN NOT BE FREE; SOMEBODY HAS TO PAY FOR IT!
You have to make a calculated, logical, financial and practical analysis of the health care universe, compare it to the 11 most commonly referenced worldwide universal plans, and then build your program based on the realities and affordability for both providers and users.
The ACA was designed on ideology, the worst possible approach.
BUT SOME COUNTRIES HAVE UNIVERSAL HEALTH CARE, THEIR CITIZENS GENERALLY LIKE IT, AND WE CAN USE SOME OF THEIR EXPERIENCE TO DESIGN A PROGRAM THAT MAKES SENSE FOR AMERICA.
First, though, let’s look at the real world and how to address it: America consists of 50 somewhat independent states, so input is needed from all; different states have different health problems, populations and needs; insuring those with pre-existing conditions or adding elective procedures necessarily raises costs; and breaking needs down can help identify the best solutions.
However, before we get into the details, you have to remember the current medical system inadequacies are a combination of botched government oversight and regulations (like limiting where people can buy insurance), lack of vision on the part of the medical industry and their associations, primarily the AMA (which, by the way, represents only 20% of doctors), and insurance companies. All 3 must work in concert to arrive at a solution; however, given the state of our politicians it is unlikely Democrats and Republicans will be in sync to find a solution.
We learned with the ACA that one sided government intrusion is never the right way to proceed; the ACA has given us record doctor retirements, a system that emphasizes paperwork over health care, insurance companies pulling out because they can’t afford to insure, the government mandating certain fees causing doctors to drop medicare, and other factors including the Act itself is more than 20,000 pages.
SO HOW DO WE PROCEED?
First, let’s look at the countries we can build our model on, then at the realities of medical needs in America and then possible solutions:
COUNTRIES THAT OFFER UNIVERSAL HEALTH CARE:
- Sri Lanka – offers universal health care and private health care as well.
- Brazil – Offers free health care as a constitutional right. However, Brazil is imploding so changes will come.
- Argentina – Most citizens covered under government and/or union plans.
- Luxembourg – Tiny country with universal coverage but premiums are paid half by government and half by citizens. Requires citizens to buy insurance.
- Spain – coverage for all by payroll deduction. However, Spain’s unemployment as high as 22% makes this plan subject to change.
- Germany – a system of public hospitals but private hospitals are growing. Requires citizens to buy health insurance.
- Greece – system was highly rated until financial crisis. Citizens required to buy insurance but many cannot afford to now.
- Finland – another tiny country with universal health care.
- Sweden, Denmark, Norway -We bunch these together because they are tiny countries with very high taxation. In Sweden it takes 25 weeks for heart surgery and more than a year for a knee replacement.
- Canada – universal system that provides care for most citizens but Canadians often come to US to avoid long wait times.
NOTE: When combined with mandatory deductions and other taxes each of these countries has a 50%+ tax rate. If Americans want universal health care paid by government they have to accept much higher taxes than currently paid.
The World Health Organization did an exhaustive study and concluded that Sweden and Canada ranked very low in actually delivering quality healthcare to their citizens. The problem seems to be that having universal health care does not assure access to universal health care. Britain, for example, with a population less than 1/6th of the U.S. has 900,000 people waiting just to get appointments and cancels more than 50,000 surgeries a year.
There are other countries that offer universal health care: Cuba (only Michael Moore would want treatment there), North Korea and other oppressive countries. However, it is well known party leaders and other powerful people get access to quality health care but the common citizen does not.
WHAT CAN WE LEARN FROM THESE OTHER COUNTRIES? (And why didn’t we learn before enacting the ACA?)
Here are some facts we should consider:
- The idea of universal healthcare is very popular and desirable.
- Most people in America seem to support a single payer system because it sounds simple.
- We cannot depend on government/politicians alone for a solution.
- We cannot depend on doctors alone for a solution.
- We cannot depend on insurance companies alone for a solution.
- We cannot depend on lawyers alone for a solution.
The very first step in creating a system is a study – an actual study, not something by a ‘think tank’ that works for lawyers or insurance companies – that looks at exactly where health care dollars are going? How much, for example, goes to heart surgery; how much to elective surgeries; how much comes from smoking and/or obesity; how much goes to return visits to hospitals due to infections, etc.
Then we should look at unavoidable catastrophic medical situations: heart or other organ transplants, short and long term cancer care, congenital diseases, traumatic accident with major health issues, and others. The point here is we can put a cost to these and create a ‘pool’ fund to take care of people who suffer from these. It would be nice if this fund was a ‘setaside’ at no cost to those who suffer unimaginable health catastrophes.
Next we should look at pre-existing conditions. We need to know what the most common pre-existing conditions are, the causes and the cost. Maybe a one time offset could be arranged to make it affordable to care for these.
Then we should look at ‘avoidable’ medical needs – including obesity in many cases, smoking, poor diet and other causes. The cost should be established and those who enroll should be given an either/or choice: your insurance will care for you now but you either change your lifestyle or future care comes from your wallet.
Next we should look at the large well of people who rarely if ever need health care, regardless of age. These people should pay a minimum premium to assure access if health care is needed. President Obama made a critical mistake when he told younger people they could wait to buy insurance …
In the long term we need to change the methodology of the medical industry from treating the effect to remedying the cause. Too many doctors today are, quite literally, ‘drug pushers’ and/or ‘body mechanics’ who provide patients a panacea to take care of today. The medical industry could learn a lot about pain management and effective care from the dental industry; 40 years ago a visit to a dentist almost caused a heart attack; today’s visits are virtually pain free no matter what treatment is needed.
There has been an explosion of outpatient facilities for emergencies, surgery and other care in recent years. We should study what they are treating and let people purchase a plan to take care of common issues. For example, my dentist has a plan that allows me to pay $200 yearly for full X-rays and two cleanings. Maybe a flat fee to cover a certain number of visits and minor treatments for colds, etc, should be considered.
Under no circumstances should health care be 100% free! Why? My experience over many years has been that families with full employer paid coverage run to the emergency room every time they get a sniffle. If some cost was involved people would think twice.
Trauma centers could be set up in various areas to cover those kinds of accidents the local hospital is really not capable of treating. With helicopter transit an accident victim can be treated at the scene and then flown to a trauma center. This would free hospitals from having very expensive seldom used equipment.
We have to analyze the efficiency and affordability of hospitals. Billing alone seems to account for massive mistakes, but we also know most hospitals are horribly inefficient with the exception of some corporate owned one that have an emphasis on money rather than people.
Corporate hospitals – and consolidation has led to many – carry one intrinsic problem: they tend to have maximizing insurance payments as their primary goal. This is a really tough one to deal with but has to be at some point.
There are other issues we have to consider; for example, the huge aging population will skew every curve for the next 30 years or so.
Now how do we administer a universal or socialized medical system?
Some would say Medicare is such a system and it is to an extent, but it is not fully government operated.
The problem many have is giving a very large part of the economy of the country to a government that, quite frankly, has not earned our trust or any privileges in recent years.
Government by its very nature is a bureaucracy and a wise person once said,
“The purpose of a bureaucracy is protect and grow the bureaucracy.”
Vladimir Lenin, no friend of a free market said, “Socialized medicine is the keystone to the arch of the socialist state.” He further said control of the medical system would facilitate control of other facets of the economy.
So there is a huge danger with a universal government centered health care system which is why so much care should be taken to design one.
On the other side of the equation we have the insurance companies and even the medical industry that have not been friends of real reform. As we saw with the Affordable Care Act large donations the insurance companies gained promises from the Obama administration: this is crony capitalism.
So we have a broken health care system, a broken political system, doctors who have not been as helpful as they could be, and insurance companies that will have to pushed to be constructive.
And this brings us to the critical question: HOW DO WE FIND A SOLUTION THAT WORKS.
President Obama proved an omnipotent government cannot ‘fix’ the system.
Lobbyists and public companies don’t seem interested in a solution.
The American Medical Association (which represents only 20% of doctors) has not been helpful.
And lawyers do not want to give up their monster settlements.
This may be the best test of the new president and his ability to negotiate with a variety of parties. This is also a case in which many American citizens are shortsighted – they just want ‘free’ and don’t consider the rest, the media is totally out of touch, the politicians have their health coverage, and doctors are retiring so fast they are not likely to want to be part of the next step.
An important consideration today is the pressure on the ruling politicians – from both media and the other party – is to get something done fast; well, this was the problem the first time. We believe a quick ‘solution’ will be offered but will include the challenges any quick fix does. So we are not hopeful a long term, practical solution is at hand.
We do think there will an improvement mainly because the existing ‘solution’ is so bad.
We believe the studies should come first, the numbers should then be published by an independent auditing firm (so those who report the findings can’t skew them to their liking) and then a panel of experts from the insurance and medical industries and the public at large should be tasked with designing a plan.
The plan should then be presented in steps, cost considered in each, and expected and real results published.
Then a test sampling should be put together, the methodology implemented and measured and then, if it works, adopted on a larger scale.
As the plan is developed it should be compared with working models in other parts of the world and tweaked to take advantage of the knowledge gained elsewhere.
Also considered, but not part of the ACA, is the total universe of taxpayers to support the system. If we go to a universal system we can’t have cutouts for unions, friends of politicians or others.
UNIVERSAL WOULD MEAN UNIVERSAL; EVERYONE WOULD HAVE TO PARTICIPATE.
After all this we may discover a true universal plan is impossible. If so, we can target the areas of greatest need, find a way to work with them and gradually built a more effective, patient centered coverage system.
But, along the way, we would have a realistic assessment of a national challenge, get the bureaucrats and lobbyists to ‘report’ to someone who can’t be bought and expect productive action, not something we expect from politicians today.
Never said it would be easy!
Your thoughts welcomed …