Molly's Path to Single Payer Healthcare

The American Healthcare System

The USA is ranked 37th in the world in respect to overall healthcare systems (WHO) while we spend by far the greatest amount per capita and yet have 30 million uninsured and many more underinsured.  The ACA was very successful in increasing accessibility and protecting individuals from a private market that denied and capped coverage. It brought us a little closer to universal coverage but it continues to rely upon the utilization of a private market structure that values profit over performance and personal health.

As of 2013, U.S. government's paid for nearly two-thirds (64.3%, $1.9 trillion) of all healthcare expenditures in our nation. Direct payment programs (ex. Medicare, Medicaid, VA) cover about 48% of outlays. Government payment of public employee health plans account for 6.4% and the US loses tax revenue through employer health plan subsidies of 10.1% total healthcare costs. The ACA increased total expenditures by direct subsidies as 8 million joined the Market Place and many received tax subsidies.  Early assessments of new enrollments estimate by 2024 the government share will be 67.3%. Governments in the U.S. already assume by far the majority of financial responsibility for our existing healthcare system.

The Problem

Our current healthcare system is laced with inefficiencies due to administrative waste (profit, advertising, multiplicity of plans, lack of simplicity), improper incentives to doctors and consumers, and misdirection of the control of care. Under our current system, there is little democratic control of our healthcare sector. While government may administer 64% of all healthcare in America it is the strength of lobbying and campaign donations by private corporations in Health Insurance, Pharmaceuticals, Medical Device Providers and large HealthCare Provider Networks that dictate patterns of care, availability and access to care, the costs of care and the prices of treatments and diagnostics used to provide your care.

These companies obviously act with their stockholders, not patients, in mind. Their motivation is profit oriented and the wealth they derive comes at the expense of the American people!  Republicans like to say that you should have freedom to choose your doctor but you know well enough by now that both you and your doctor have limited freedom due to the rules of the private health insurance companies.  Insurance companies and other corporations should not dictate or direct medical care based upon their desire to maximize profits.  A modern and democratic healthcare system should be founded upon the universal and efficient provision of quality care!

Immediate Steps to Improve Care and Prep the System

Our current system prioritizes profits, not care, so removing profit incentives both lowers costs and improves care. Certain structural improvements must be made to implement Single-Payer and it will take time to implement and realize their cost savings. Many of these quality-improvement reforms will have bipartisan appeal, and I will fight for them even if I serve in the minority in 2019. Reforming 1/6th of the economy will take time, so we cannot wait for control of both Houses and the Presidency to start. Fortunately, most reforms are both the financially responsible, and humane thing to do.

Expanding Coverage

  • Expand Medicare to 55 & over and CHIP to all children 18 & under and pregnant women. Lowering the age will also increase job availability for younger workers.

  • All medical plans must include comprehensive Dental Care as part of the plan.

  • Alternative pain treatments with evidence-based results (ex. acupuncture) covered by insurance and Medicare/Medicaid/VA/CHIP.

  • Birth control and hearing aids (personal sound amplification devices) should be over-the-counter.

  • Eliminate the ‘family-glitch’, so the cost of the whole family’s health coverage is considered when calculating ACA subsidy eligibility.

Structural Improvements in Care Delivery and Payment

  • Lower drug prices: Medicare negotiates drug prices and consumers can buy from Canada; ban prescription drug advertising to consumers and provider bonuses for using prescription drugs.

  • Universalize Electronic Medical Records (EMRs): Your records from one doctor will be available at another. Create open-source, quality focused, EMRs developed by practitioners/providers.

  • Hospitals publish common procedure price lists: Patients will have more agency in markets with multiple providers and insurance can predict out of network costs for better coverage.

  • Implement ‘best practice’ software: Hospitals rein in unnecessary diagnostics and treatments.

  • Increase non-physician providers (ex. NP, PA): Expand programs in University partnerships to save costs and incentivize them going to underserved areas with loan repayment.

  • Replace medical device tax with percent profitability cap: make-up revenue with taxing capital gains as work income (4x more revenue).

Structural Improvements in Care Development

  • Patent Reform: Ensure taxpayer funded discoveries benefit the public! Give patent ownership back to funding body and researchers, but still give exclusive licences. Crack down on limited-utility tweaks renewing patents, which keep generics from use.

  • Do research in real-world populations: Many drugs and diagnostics do not work well in women and non-studied populations because they were not tested in clinically-relevant populations or models. Expanding better model use through researcher training and improved standards, will results in more effective treatments, improving quality and lowering costs.

Segue to Government-Paid Care

Government insurance requires political firewalls and avoiding budgetary austerity that can cripple healthcare innovation and breakthroughs in treatments, quality of care or, the entire system itself. Development of the Public Option will allow for structuring of a comprehensive government plan and give a lower-cost alternative to the private market. The well-implemented Public Option will also create a public thirst for Universal Single Payer.

  • In step one, black boxes around hospital billing need to be removed, so insurance can better compete with a broad network plan like the Public Option.

  • Increase payouts from current Medicare scheme so as to not induce austerity to the system or undermine healthcare provider job market. Better predictors will be possible if the Government has electronic medical records and provider price lists.

  • Develop non-political committee of providers and patient care advocates to determine plan coverage. Without this political firewall, the same misogynists who think pregnancy can be an excluding pre-existing condition would be determining care options.

  • Require physicians and hospitals that receive any federal funds to accept public option, but give initial underwriting of risk, so government covers losses over total patient pool. This should not be necessary later after the costs are more predictable and payouts adjusted.

Final Implementation of Single Payer Healthcare

In order to provide comprehensive care and lower our expenditures on healthcare costs we must ultimately move away from our private health insurance and employer-based system to a single-payer (Federal Government) system. This will reduce administrative billing waste and profits while maximally increasing quality, accessibility, efficiency, and affordability. The nature of our private market system has historically proven that it cannot, and will not adequately cover all of our citizens while containing costs.

  • Providers choose to be in the public or private system. The private system must be completely independent, so healthcare profits are not subsidized by the public.

  • No deductible, no premium (No up-front costs). No copays for preventive and essential care.

  • Small copays for elective and specialist care to incentivize proper use of the system.