Our healthcare system has become unsustainable. We can prop it up with short term fixes, but those will only postpone an inevitable collapse. We must take a more comprehensive approach.
But to understand why we need to change, why we are stuck here, it is helpful to review how it all came to be in the first place.
Here is a summary:
– Employer-sponsored health insurance plans took off during WWII. Although wages were controlled, benefits such as health insurance were not, and so companies added health insurance as a way to attract workers.
– After the war, President Truman proposed a system of public health insurance. Although it was highly popular with the public, it was fiercely opposed by businesses and medical lobbying groups. Unfortunately, in order to avoid a costly political battle, many labor unions chose to campaign for employer-sponsored coverage instead of the public option. Thus, the idea of a public health insurance system ran out of political steam, and failed to pass into law.
In other words, despite broad public support for the idea, organizations used their influence to derail a system of national health insurance. Are we surprised that they still resist it? Add in the insurance carriers that grew up to serve this system, and we have a mighty array of ‘stakeholders’ invested in maintaining the status quo.
This thicket of stakeholders have not only hindered the development of a public health system in the U.S., but by their practices have actually increased the costs we all pay to see a doctor and fill our prescriptions. Healthcare in this country consumes a greater share of our GDP than of any other economy in the west.
Glib political statements only obscure this complex reality, and insure that nothing fundamental ever actually changes.
I believe that the answer is Medicare, a platform which is ripe for conversion into this nation’s first true common health insurance system.
The goal is to transform Medicare into something like Social Security. That is, it should be basic coverage just as SSI is basic income for retirees. Like SSI, Medicare parts A & B are far from complete, just as most people have additional retirement income, but the coverage Medicare provides is sufficient to meet basic needs.
Here is what I suggest should happen, in the following order:
- Enroll all children immediately, along with prenatal and obstetric care. This population is the healthiest and thus the least costly, but for families with low incomes, the cost of even routine care can be hard. Even broken bones and the like can be financially disastrous.
- Enroll all lower priority groups (5-8) of the VA in Medicare, including those not needing specialized care due to military service. Merge non-uniformed military and their families (clients of Tricare) into Medicare, leaving only those on active duty.
- Allow small businesses to enroll employees in Medicare Part C plans, paying an appropriate premium just like current health care insurance.
- Allow individual adults to enroll in Medicare for a premium that reflects the calculated cost of Parts A & B, with the option to choose part C and Part D.
- Medicaid & CHIP would be absorbed so that there would be no means tested program at all.
In this way, Medicare would evolve into the basic provider for everyone, and all the stakeholders would evolve with it. Insurance companies would still exist, but as supplements that handle specific places and groups.
Yes, this would limit the profitable options of some individual businesses; however, the broader economic impact will be a net positive. Healthier citizens mean healthier families, workers, and communities. By assuring all have health insurance, the playing field is made more level, especially for new businesses. Far from being intrusive, as some might think, this program will go far in promoting the general welfare that the Constitution spoke of, and on which economies and societies thrive.
But what about the cost?
Private premiums would go down — the program would cover less. However, many of those dollars would now be filtered to Medicare, meaning only some net change for the less. We would save money by spending it more efficiently. Presently, Medicare spends far less than private insurance on overhead, which means more of that money is going towards the patients and the care they need.
The step-by-step development of my plan means that this efficiency is more likely to continue. Hospitals and doctors’ offices would be able to spend less. Under this plan, approximately $400B (over $1000 per person in the United States) would be saved from the inefficiency of our current system.
Is this enough?
Skyrocketing drug prices are another notable issue. The whole question of for-profit medicine is itself worth asking. But once we empower Medicare to be this nation’s public health system, the other issues become smaller and more possible to address.
We’ve been told for decades that introducing a comprehensive public health system in this country is impossible — a fantasy — but I’m here to tell you that it’s not. It is possible. With our voices, our work, and the will of the public behind us, we can bring about a change that can create a healthier society for all of us. — Fred Wooden
To read more of Fred’s official statements, visit http://fredwooden.com/issues-ideas/