National Universal Health Care - Could it Work in the USA?

The United States is the only nation in thePractitioner level. Compensation based upon health
industrialized world without a universal health careof the patients. Healthier patients, doctor makes
system. The oldest universal health care systemmore money.
is in Germany, which had its inception in 18836. Medical school 100% paid by government in
under Chancellor Otto von Bismarck.exchange for 10 years service as a Federal
Let's lay an important ground rule before weemployee. This would include additional training in
begin. Traditional insurance policies covermedical specialties. Compensation levels could be
unexpected but predictable occurrences. Forset lower since there would be no school debt.
example, an auto policy covers an unexpected7. FedGov sets minimum standards for care.
collision. But that policy does not coverInsured persons are free to choose their own
maintenance costs which are a normal part ofdoctors. Patients can choose specialists without
owning a vehicle. Health insurance has becomefirst seeing Primary Care Physician.
maintenance insurance over the years, paying for8. No insurance company precertifications
everything from regular checkups and toothnecessary.
cleaning to heart transplants. And, with some9. System includes mental health, nursing home
group insurance copays at $5 to $20, the conceptand hospice care.
of deductibles is becoming archaic.10. FedGov sets prices for pharmaceuticals,
So, in considering a single-payer cradle-to-gravemedical procedures and medical supplies. FedGov
government healthcare system, the old conceptssets wages for all medical employees, including
of insurance and risk must be put aside.administrators, nurses, med techs and doctors.
Single-payer healthcare is NOT INSURANCE in the11. Tort reform. If health care was universal from
strictest sense. It is a massive Socialcradle to grave, torts would be limited since the
Security-type program, into which tax revenuespatient would automatically be eligible for additional
flow and from which health care payments flowmedical care required by malpractice, an
out to health care providers.unintended consequence of treatment or a
This article does not advocate a single-payermedical complication. Doctors would still be liable
government-run healthcare system. But it doesfor negligence, but awards would not need to
look at what a single-payer system might lookcompensate the individual plaintiff/patient for
like, and reasons why it will not work.anticipated medical care into the future.
In December 2008 The McKinsey Global Institute12. Electronic Medical Records, a database of all
issued an exhaustive 122-page report on healthmedical records for each patient, accessible by all
care costs in America, entitled "Accounting for themedical providers. Would eliminate all duplication.
costs of US healthcare: A new look at whyLiving wills and advance care directives would be
Americans spend more." The best estimate ofpart of every patient file. This has the potential to
American healthcare costs is about $2.1 trilliondrastically reduce end-of life invasive care and
annually.duplication of procedures.
Here is a summary list of its findings:13. Individual health insurance policies would still be
1. Administration costs in the US are much higheravailable for those that wanted a higher level of
than in most countries around the world. Thiscare, and would be excess insurance, like a
partly due to the privatization of some healthPersonal Umbrella policy.
care, resulting in profits for shareholders.14. Private medical providers, including doctors and
2. Pharmaceutical costs: Direct-To-Consumerhospitals, would still exist, offering custom care
Advertising encourages use of newer, morefor those willing to pay extra for it.
expensive drugs, a practice only allowed in theI know this is a cursory look at universal
USA. Also, pharmaceutical lobbyists werehealthcare. I know I've left out important features
successful in getting Congress to ban collectiveand benefits. But I'm trying to wrap my mind...and
bargaining for Medicare Part D, resulting in theyours...around a concept that I fear is in our
highest drug prices in the world. Also, the patentimmediate future.
system for new drugs allows drug manufacturersThe big insurance companies have completely
to patent and charge more for non-novelscrewed up the health insurance marketplace in
medications.the United States. So, if they get left at the dock
3. The absence of a universal system thatwhen this new ship sails, I won't shed any tears.
prevents risk-pooling, and the selectiveThey get what they deserve.
underwriting done by insurers. This leaves millionsNow, here is why I don't think that the system
uninsured, and the uninsured avoid treatment untiloutlined above will work.
problems are more critical and more expensive.1. The Federal Government is broke. They are
4. Huge fees of specialist physicians for theiralready running trillion dollar annual deficits. In order
procedural skills, rather than primary care thatto stave off governmental collapse, the Federal
emphasizes preventive health care, early diagnosisReserve is printing paper money as fast as it can.
and disease management.Eventually, inflation will sink the ship of state. To
5. Defensive medicine: Excess costs andabsorb the healthcare system into the Federal
duplication of health procedures in order toGovernment which represents about one-seventh
protect medical providers from malpracticeof the economy, is a bridge too far.
lawsuits. Lawsuits and jury awards themselves2. Funding this new healthcare system would
don't cause a large amount of monetary damage,require increasing taxes significantly. Insurance
but the tort system creates a culture in whichpremiums would be turned into tax payments.
physicians are paranoid and make health careThere is presently an IRS business deduction for
decisions with lawsuits in mind, rather than patientinsurance premiums for corporations. The business
interests first.lobbyists won't want to give up this deduction and
6. ICU Care: The costs of care at the end of lifewill fight it.
are wildly inflated, many times eclipsing the health3. Pharmaceutical companies lobby Congress. They
care costs incurred in an entire lifetime. This iswill fight any system that controls drug prices and
partly due to heroic efforts of lifesaving, painthreatens their profits.
management, and poor records.4. Trial Lawyers have a powerful lobby in
7. Electronic Medical Records (EMR) systemsCongress. They will fight medical malpractice tort
would be of great benefit in managing living wills,reform.
advanced care directives and previous treatment5. Medical providers, the American Medical
records. Without EMRs, doctors regularly orderAssociation and other medicine-related groups
redundant tests and procedures because medicalhave powerful Congressional lobbyists. They will
information management is so inefficient.fight reforms, just like they do now.
The McKinsey report doesn't recommend a6. Insurance companies will be forced out of
universal healthcare single-payer system. It simplybusiness if the Federal Government takes over
tries to provide accurate information to thosethe healthcare system. Insurance companies hold
who will be making policy regarding healthcare intrillions of dollars in US bonds and other municipal
the USA.securities. They will threaten Congress with the
Here is what a universal healthcare system mightcollapse of the bond market if Congress passed a
look like. This takes the best characteristics fromnew system that leaves them out. All the
healthcare systems around the world.insurance companies would have to do to crash
1. Funding through individual taxation for wagethe bond market and cause the collapse of the
earners and self employed persons. Low incomeFederal Government is to sell off a small
persons subsidized. Should tax be based uponpercentage of their bond holdings all at once.
age? Should the tax be calculated as a percentageIn conclusion, I recommend looking at any Obama
of income, like in the IRS Tax Tables and FICAAdministration proposal for universal healthcare in
payments?light of the competing groups in the medical field.
2. Medicare, Medicaid, the VA healthcare systemEach group must be bought off for their
and all other Federal healthcare systems would becooperation, and in turn each one will buy off
rolled into the universal system. That would includeCongress to get what they want. Some things
the healthcare benefits for Federal workers andnever change.
members of Congress.The single payer healthcare system that emerges
3. No individual underwriting. All living persons of USfrom Capitol Hill, the system that will affect the
citizenship are covered. Non-citizens with taxablehealthcare of each American, should adopt as its
earnings could be taxed and covered.logo the duckbilled platypus.
4. No deductibles. Copay for any doctor visit ofThat's the animal that looks like it was designed
$5-$20.by a committee.
5. Prevention-based health care at the General