Monday, October 13, 2008

Can Universal Healthcare Reeeeeaaaally Work?

This was the question I asked my boss during a political discussion not too long ago.
"Sure," he replied, "they just have to lower their costs." If only it was that easy...

This is my first attempt at a political blog, so bear with me. I have been thinking about blogging on this topic for a while. Part of this blog was a response I wrote on an online q&a board a few months back. Last week I had thought about it while I was frustrated with an insurance group but I didn't want to spoil the happy auntie euphoria. This weekend I thought about it some more as I engaged in activities that included exploring bat-infested abandoned mines and scrambling up and down boulders with the consistent thought: "I don't have health insurance, I better not break anything..." It may seem a little ironic that the licensed health care provider who performs physical exams and prescribes your kid's drugs does not have health coverage herself. Fortunately, for me that will change in a few more weeks. Unfortunately, that's not the case for millions of Americans.

We all know that the current health care system is wracked with problems. Our healthcare system is crippled. We pay more money per capita on healthcare than any other developed nation in the world, we still have large populations of the medically underserved, health care costs are grossly inflated, insurance companies have way too much overhead/administration costs (CEOs are being paid way too much), there is a severe problem of Medicaid fraud and abuse, and health care providers and patients are frustrated. No one wants an elderly person on a fixed income to struggle with paying for their medications, a person to be denied a surgery due to their inability to pay, or a child to go without proper medical care. My last point is what I am going to use as a model for this blog because most children, if their parents are responsible enough to look into it, are able to get healthcare, whether through government sponsored insurance (Medicaid) or private insurance. No child should be going without proper medical care in the United States (or at least in California, anyway). I know this because all of my patients are covered under two Medicare insurance branches. For the past couple months I have been able to get a greater understanding of this type of insurance and have pondered about its potential as a model for a universal healthcare system that many politicians are pushing for. Another question: Is a single-payer system the best cure for America's healthcare crisis? I'm not sure if it is, but if it happens, there has to be A LOT of CHANGE on everyone's part. Everyone including every citizen of the country. Below are some points to consider when comparing healthcare systems and some of the negative points of why such a system may not be the best/easiest option (nothing will be easy) for the United States. This is also keeping in mind that the single-payer system will either be controlled or otherwise heavily influenced by the government.

1. Every health care system in the world has three main objectives: Access, Quality, and Low Cost. Unfortunately you can only pick one or two of those things for your system. No healthcare system can have all 3 nor is there a perfect system.

2. Different American mentality. Americans want the best, Americans want choices, Americans want it now. Someone with bone-on-bone knee arthritis living in daily chronic pain doesn't want to wait 5 years for a knee replacement (I heard that's the average wait in Canada). A friend's father flew from Canada to New York for his heart bypass that he paid with his own money because he didn't want to wait months and months for it and risk having another heart attack while he's waiting. I have struggled recently as one of the government health insurance groups has began to crack down on medications that are not listed on its formulary. An allergy sufferer who had been on the same medication for a very long time was trying to get refills. I write on the prescription, "intolerant to A." The pre-authorization was turned down. The insurance company only offered two choices of nasal spray: Drug A or Drug B. "But he's allergic to drug A!" says the grandmother (intolerant to the side effects most likely). Still can't get favored drug... Drug B it is, or nothing...

3. There will always be people who abuse the system and wastes tax-payer money. It already happens with Medicaid, I've seen it. Just one example from a universal-healthcare country: My uncle was in an accident in Norway and his hospital roommate, who was perfectly healthy, was there just because he wanted a "holiday." But it's okay, the government will pay for his holiday. People get ticked off when their tax dollars are misused. People aren't too crazy about how high taxes would have to go to provide universal healthcare. On another level, people will feel like they can go to the doctor for every sniffle or insect bite they get (trust me, I see it every day), because, hey, they're paying for it with their taxes. Never mind the fact that they are exposing themselves to more germs in overcrowded clinics...

4. Reimbursement for government-sponsored programs is horrible. I was talking with one of the other doctors who sees some of the same patients that I do and she says that we (healthcare providers) are only paid for one visit per patient per month, and it's not much of a payment to start with. Therefore, a patient can come back as many times in a month (i.e. follow-up for visit #2, mosquito bites for visit #3, runny nose for visit #4. cough three days later for visit #5 - trust me, this happens) and the provider is paid for the first visit only.

5. Many people don't trust the government handling healthcare. They have seen how efficient the government is handling other issues.

6. There are some lifestyle issues that affect the cost of healthcare. People in the United States live differently. There's fast-food on every corner. We spend too much time in cars or indoors. We're overstressed. Other countries get 6 weeks of vacation a year. Poor lifestyle contributes to many chronic health problems such as diabetes, high cholesterol, arthritis, coronary artery disease, high blood pressure, and other problems. Chronic diseases are VERY expensive. A large percentage of people in the United States are overweight. Diabetes care (90% Type 2) used up 10% of government health spending in 2006. That's billions of dollars, and that will probably rise in the years to come. There's other cultural differences that can impact health and health costs.

7. Cost will still be an issue. Where will the money come from? The sponsored-insurance groups of my patients have seen some scary financial difficulty lately, but at least the Governator passed a bill recently that supplied more money. A temporary Band-aid.

8. Are people in single-payer healthcare system-countries satisfied with what they have? Many say no. Some countries are looking for other options. I heard that Canada passed a law making it illegal for Canadians to seek medical care in the United States. I don't have a source on that, but if it was really true...

So are universal healthcare and a single-payer system the main solutions to the United States healthcare problems? That's for the people to decide.

1 comment:

Mr. Hall said...

An excellent and insightful blog. Thank you for sharing. It is nice to get an opinion an observation from someone who has first-hand knowledge of the profession.