my blog
Redesigning our failed healthcare system: this is NOT rocket science.
The United States healthcare system has failed. These are the three major problems with our system:
First, it is extremely expensive - we spent 17.8% of our GDP on healthcare in 2021, which was far more than any other comparable, advanced country spent (Gunja et al., 2023, Graph 1). The cost of care itself, from consults to surgeries to drugs, is often unattainable for many.
Second, although we spend far more on a relative basis compared to other countries, we have significantly worse health outcomes. For example, we have the lowest life expectancy, highest rate of avoidable deaths, and the highest infant mortality rate of any wealthy country (Gunja et al., 2023, Graphs 4, 5, & 6).
Third, Americans have not been given the right to healthcare. Despite the efforts of Obama Care, millions of Americans remain uninsured and do not have access to basic healthcare.
Before discussing a new model for our healthcare system, I’d like to briefly discuss related changes that we could make within our communities to increase population wellness. 42.8% of the US population is obese (Gunja et al., 2023, Graph 9). Yes, read that again! Almost half of our population is obese. Most Americans live a sedentary lifestyle, consume low quality, sugar laden food, and rarely exercise. We need to get a handle on the fast food chains that line our highways and the endless junk foods that line the shelves of our grocery stores. People need to begin eating a balanced diet, so we somehow need to find a way to make healthy food affordable to all. Through a combination of taxes and incentives, we could encourage food companies to focus on providing healthier options. City planners need to design walkable cities so people are up on their feet and out of their cars. Vapes should not be landing in the hands of high schoolers. I could go on, but these are just a few of the countless things we could change to improve our health without changing the medical system itself.
When it comes to reforming our healthcare system, my proposed solution is not rocket science! The first step is to grant all Americans the right to healthcare. To do this, I propose that we adopt a single payer system. The government would collect taxes from citizens, employers, and employees, and the money would go into a single health fund. The government would provide subsidies for those who couldn’t afford to contribute. We would get rid of private health insurance altogether. This system would finally give all Americans, the young, the old, the poor, and the rich, access to healthcare whether the care is basic, emergency, or elective. We are the only wealthy country in the world that hasn’t done so already. In the US, we have decided that the elderly, veterans, and prisoners are the only citizens who have the right to healthcare. It is time for that to change.
Another essential element of the new system would be to maintain a high standard of care while containing costs. This single payer system run by the government would operate differently than it does in countries such as England and Australia. The health clinics and hospitals would continue to be privately owned and operated and therefore compete for their customers. The government would not own the hospitals, nor would they employ the doctors, nurses, or anyone working in service delivery. Utilizing a similar idea to Japan’s price book, I think that at the beginning of each year, the government should negotiate with hospitals and pharmaceutical companies to set standard prices for every single procedure and drug (PBS, 2008). The prices for all care would be the same all over the country (with adjustments for cost of living), and doctors can charge this price and no more. The key here is to negotiate prices so that they are low but with a reasonable and fair margin built in so hospitals, doctors, and all types of medical or drug companies can make an adequate profit. The hospitals and medical companies would have to accept this price because the government would be the only one paying! Having standard costs and acceptable profit margins would allow hospitals and doctors to compete with one another for patients, and in doing so they would have to maintain high quality, timely care. It would also allow pharmaceutical companies to keep researching and producing new or improved drugs.
By switching to a single-payer system, Americans would have the peace of mind that they can get the care they need and no longer go bankrupt. This would be a drastic change from our current system, where hundreds of thousands of Americans go bankrupt each year from medical bills. All citizens would be able to choose a GP in their area, who they can visit anytime at no cost at all. In fact any medical bill, whether it be for a $20 drug or $20,000 procedure, would go straight to the government, and the patient wouldn’t see any bills at all. A greater emphasis would be put on preventative care, which would help avoid health issues and related costs down the line. Since everyone would have a GP, getting preventative care would be easy. Everyone would be issued a physical health card or a card they can keep on their phone which contains their medical file. The card could be scanned at any doctor's office or hospital and any bill associated with your file would simply be sent to the government and paid right away. This would greatly reduce administrative costs, which currently account “for 15-30% of health care spending” (HealthAffairs, 2022).
Overall, the single payer system would solve so many of our issues. It would cut any ties between employment and health insurance, recognizing that everyone has a right to healthcare. It would reduce massive amounts of administrative waste as there would no longer be a need to process insurance claims. A single payer model would save profits currently paid to insurance companies and centralize the buying power when negotiating rates with service providers, pharmaceutical companies, and medical device companies, so we would have regulated, transparent prices and margins. Lastly, it would ensure that everyone has access to high-quality healthcare which, in turn, would improve our health outcomes.
However, I am not confident that the US can attain this system anytime soon. We have gone so far down the wrong path and it seems we are only capable of putting bandaids on our issues. For anything to change, we need to cut our obsession with money. Pharmaceutical companies make massive profits and we have only been able to negotiate the price of 10 drugs. Insurance companies also profit by charging extremely high premiums. Our system, if you can even call it a system, is rooted in ‘regulatory capture.’ Large corporations such as insurance and drug companies pay lobbyists in DC to influence and even sometimes write the regulations that control their industry. Then, politicians enact these regulations and receive campaign contributions from the same companies. We need to get money out of politics and sever ties between healthcare and obscene profit. We need to change our mindsets, adopting one that values quality of life over money.
I think that by having one unified system, as opposed to the fractured system we have now, we would become far more efficient, save heaps of money, and more importantly, have a far healthier population. Imagine if we could cut our healthcare spending from a whopping 17.8% to just 10% of our GDP. We could allocate the 8% saved to other areas such as education, affordable housing, redesigning our cities, and invest in the production of more nutritious food - all of the things I discussed earlier which would further contribute to promoting a healthy lifestyle. We could even reinvest the money in medical research, strengthening our healthcare system even more.
Extra thoughts:
Within the system itself, I think there are many things we should modify in regards to the actual delivery of medicine and care. One area that needs attention is end of life care. We currently spend millions of dollars per year to keep brain dead people alive on machines. In many cases, families don’t want to let their elderly loved one go, even when the chances of them waking up and being able to live a fulfilling life is extremely low. As a result, their loved ones are kept “alive” on machines, often for months, and sometimes for years. Not only is this costing our system millions, crowding our hospitals, and wasting resources and doctors’ time, it is simply immoral to keep these people “alive.” We must begin to draw lines. Changing the system itself is one thing, and changing medical care is another. By re-evaluating medical care such as end of life care, we can make smarter choices to save money and save people from pain.
Thanks for reading!
References
Gunja, M. Z., Gumas, E. D., & Williams II, R. D. (2023, January 21). U.S. Health Care from a Global Perspective, 2022: Accelerating Spending, Worsening Outcomes. The Commonwealth Fund. https://www.commonwealthfund.org/publications/issue-briefs/2023/jan/us-health-care-global-perspective-2022#:~:text=In%202021%2C%20the%20U.S.%20spent,higher%20than%20in%20South%20Korea.
Health Affairs. (2022, October 6). The Role of Administrative Waste in Excess US Health Spending. https://www.healthaffairs.org/do/10.1377/hpb20220909.830296/full/.
Palfreman, J. (Director). (2008). Sick Around the World [Film]. PBS.