A fellow I’ve known slightly for many years is editor of the Alpha Omega Alpha medical honorary society magazine, The Pharos. He has a lead editorial in The current issue It is titled “Now is the time to enact a US Healthcare System.
Now, don’t get me wrong. Dick has had a more successful career than I have. Many years ago I knew him and he read his acceptance letter to USC medical school in my apartment. He did well in medical school, almost as well as I did, but his wife agreed to go to New York for a high status internship and residency, setting him on a path to great success. He became a Professor of Medicine and eventually President of the University of Colorado. I have not seen him in years and suspect very little of his time has been spent in the delivery of primary health care “in the trenches” so to speak.
My wife refused to leave Los Angeles and I have, as a result, had a less prestigious career but satisfactory as anyone who has read my Memoir will see. I did harbor some resentment and the marriage ended in divorce after 18 years.
Now let us consider what this academic authority proposes. First, we are now ten years after Obamacare and some level of practicality has crept in.
The “federalism” response to the COVID-19 pandemic, medicine, health care, and the profession of medicine is not working well and needs to change. A serious societal and public review and plan of action for change is needed with regard to why and how the U.S. must improve overall health care and create a new health care system for all Americans. The U.S. is the only developed country in the world that has not determined that health care is a fundamental human right. Universal health care should be considered by all as a social good and a national priority.
There is, of course, no such promise in the US Constitution of a “right” to healthcare although we do have an Amendment forbidding involuntary servitude. Section 1
All persons born or naturalized in the United States, and subject to the jurisdiction thereof, are citizens of the United States and of the State wherein they reside. No State shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any State deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws.
Shall the federal government have the right to compel doctors and healthcare providers to provide services ? Right now Medicare pays about 13% of billed charges. This produces ridiculous fees on paper but what is the uninsured to do ? Pay 87% higher prices ? At my last understanding, a doctor may not offer a service for less than his/her/xir Medicare price. Anyway, let us see what is proposed.
The long-standing federalism approach to health care is associated with a lack of leadership, the absence of a solid plan, setup, or organization to manage our national health care. Also it is slow to respond to national and international issues. It has not worked well and leaves the country’s health care system disjointed, confusing, and expensive. The federalism approach, in which all 50 states and five territories each have their own rules, regulations, and financing, has been a barrier to providing health care for every U.S. citizen, regardless of where they reside.
I frankly don’t see the Federalism handicap but suspect nationalization appeals to some. Those darned Red States again.
One option that is often discussed is a single payor system in which the government is the only payor through tax and other revenues and manages health care as a public and social good. Currently in the U.S., the Military Health Care System, Indian Health Services, Veterans Health Administration, and Medicare are all government single payor systems. Medicaid and the Child Health Insurance Program (CHIP) are jointly funded by the federal govern-ment and state governments. All totaled, these government funded programs provide health care coverage for nearly 50 percent of the U.S. population.4
The success of the VA and the Indian Health Service is doubted by many. Both have seen repeated scandals.
The other half of the population is covered under their employer-sponsored health plan; is self-insured; or receives coverage through individual market health plans, including ACA-compliant plans; or completely lack any type of health insurance. Through the private health insurance programs, private insurance companies are re-sponsible for paying claims for their members. Hospitals, physicians, pharmacies, and other health care providers each file claims independently. Obamacare is responsible for a significant segment of the uninsured as small group plans were devastated by Obamacare.
According to Jerry Bonenberger of Babb Insurance in Pittsburgh Pennsylvania, “small employer groups with less than 50 full-time employees are experiencing an extraordinary increase in their insurance premiums for 2015. In one case, a professional services firm with 42 full-time employees received an 87% increase in their premiums for next year.”
Through the development of the quasi-independent, apolitical National Health Reserve System (NHRS) pro-posed in the Summer 2020 issue of The Pharos,(1) the U.S. would have a health care system modeled after the Federal Reserve System, allowing for government funded care for half, and private insurance for half. The role of the NHRS would be to govern, integrate, coordinate, and manage a nationwide system of health care, both private and governmental. It would be far more extensive operationally than the Federal Reserve and would be governed and managed by experts, including physicians, health professionals, and others using data, experience, evidence, and planning to operate a national health care system independently with transparency and quasi- independence from politics.
Does anyone really believe that ? At least he wants to get rid of Obamacare although it is too late, as I have repeatedly pointed out. Doctors are no longer small business people but employees with the psychology of employees. Those that are opting out to go to a cash practice are a small minority but that seems the only realistic option. I submitted a rebuttal letter to the journal but doubt it will see the light of day. In it I suggested some reforms on the lines of the French system that I described in multiple blog posts ten years ago. I think the French system would have been a better reform but I doubt that will appeal to the academics who want control. When I was at Dartmouth in 1994-95 I met many of the people who designed Hillarycare, and they were also all academics. Pelosi and Reid who wrote Obamacare (I doubt Obama had anything to do with it) at least learned to include the insurance companies in their plan. In fact, I am sure it was written by insurance lobbyists and 25 year old staff lawyers.
The abysmal implementation of Obamacare suggests that big national scale programming projects are not the federal government’s strong suit. The federalism that my former friend, Dr Byyny, opposes allows for incremental reform and some level of experimentation. A national one-fits-all program failed spectacularly. Another one is likely to fail, as well.
That was 2015.
