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“I SORELY MISS the peace of mind that comes with universal health coverage.”
Those are the words of a 32-year-old woman from Canada, who is currently a PhD student residing in the U.S. When I read them recently in the comment section of a blog, they changed my thinking about health care.
I’ve been involved in health benefits, health insurance and health plans of various types since 1962. I’ve designed employer plans. I was on the boards of four health maintenance organizations. I negotiated physician contracts and health benefits with five unions.
I lobbied Congress for changes during Hillary Clinton’s attempt at health care reform, and keenly observed the Obama-era changes. I was shocked by some of the unrealistic promises made—and the spurious claims opposing—the Affordable Care Act.
Wherever we travel, I embarrass my wife by asking people about their health care. I’ve asked people aboard the ocean liner QE2, on a tour bus in Costa Rica, pretty much anywhere—it doesn’t matter.
I’m aware of the issues and claims regarding cost, rationing, waiting times, freedom of choice and all the rest. I know that no system is perfect. Every system struggles with costs, and some systems can’t deliver care in the timely manner we might expect.
But I also know from my interviews that many people in other countries are satisfied with their health systems. Why? From their perspective, the low or minimal costs they’re charged when they receive care provide them with “peace of mind.”
My retired friend in the U.K. now pays no premiums or copays for his care. He’s convinced his health care is free. That isn’t accurate. Still, he enjoys peace of mind about his health care costs.
In the U.S., 34% of the population is currently covered by a government-run system. Yet, if I mention universal coverage—even Medicare—there’s instant controversy. It makes you wonder, what do Americans want?
There will never be a perfect system—one that has no out-of-pocket costs, unlimited and immediate access to care, and no taxes paid to support it. But there’s also no logical reason the U.S. can’t have some form of universal coverage with a public-private partnership. Nudged by the Canadian PhD student’s comment, I think it’s time we provided peace of mind to every citizen.
Sometimes, when I discuss the idea of universal coverage with people who are adamantly opposed to changes, I’ve taken to saying, “Give me your ideas for something better.” I’m still waiting.
Excellent post.
Pulling healthcare out of the workplace would eliminate a some of the noise (read:cost) in the system… and help small businesses immensely. I think there are benefits to the US system: medical innovation seems to come mostly from the US (with notable exceptions of course). Cutting edge care is pushed to the front lines: If I’m a cancer patient, I think I want it to be in the US.
For many other things – it’s wasteful and wrong-headed. My wife’s knee issues are pretty consistent, and we know what works. Insurance keeps demanding pointless tests, wasteful procedures we know don’t work, and cheaper treatments that are ineffective. It would be cheaper just to treat her with what has proven successful in the past.
Also, the current process of health care delivery demands enormous administrative effort (and the cost that goes with it.) Heck, my wife has taken that over in many cases from the medical office due to their frequent errors, which are really painful when you are spending the kind of money we were (related to our son’s genetic disorder.)
My understanding is that the advent of for-profit insurance is also immensely wasteful. Medicare overhead is about 3.5%. Add 1% for administrative costs that are picked up in other government programs, and it’s really about 4.5%. Non-profit insurance overhead is about 4-5%. For-Profit insurance company overhead is 12-15%. Their true admin cost is also about 5%, but they spend 7-10% on ‘fraud prevention’, (which becomes denial of care in many instances.) Medicare mostly doesn’t bother with fraud prevention, yet their per patient fraud rate doesn’t seem any higher than for-profits. I could be wrong on that last point, it’s hard to get apples to apples data… but I think it’s fair to point out that when people point to Medicare fraud, well, private insurance has the same issue and doesn’t seem to deal with it much better.
If the US really is exceptional, we should be able to create an exceptional healthcare system that gives us the advantages of private market incentives but also provides a reliable base level of care for everyone.
Low administration is a two edge sword. Medicare has been criticized by government auditors for not spending enough on claim review and management and for having a high level of fraud, higher than the private sector. Medicare fraud can go undetected for decades.
Private insurance is criticized for too much oversight, pre-approval, etc. patients and doctors don’t like it, but they don’t like high premiums and lower fees either.
Medicare can get away with some of what it does because it can set fees much lower than the private sector and manage costs that way which leads to shifting of costs via higher fees paid by the private sector.
The reality is that most Americans are not covered by a plan that uses insurance. They are covered by any number of government programs or in the case of medium and large employers by self insured plans where the insurer acting as a claim administration for fixed fees has no risk in the payment of claims, no financial incentive to deny a claim as it were.
I agree we can and should design a better system, but that is not going to happen as long as both the for and against points of view spew false and misleading information and patients don’t see paying for health care as their responsibility and want everything they want and immediately.
The point of view and the acceptance of their systems is vastly different in every other country I have visited and asked people about health care. I’m still trying to figure out what makes Americans so different.
It would be interesting to know how fraud is measured across private insurers vs Med