Universal health-care debate: why vs. costs — a doctor’s opinion

by James Hubbard, M.D., M.P.H.

The debate over universal health care should get hot and heavy this year.  By far, our most popular article is “Doctors Debate Universal Health Care Pros and Cons.”  Check it out and join the discussion.  Two things are certain:  No one has a surefire answer, and no matter what happens, it’s going to affect your pocketbook.

We will be in a great experiment, with us as guinea pigs.  Sure, they have universal health care in other countries, but in no nation so vast and diverse as ours. And what is universal health care anyway?  To me, it just means everyone has health care.  Everyone wants that.  The debate is how to implement it–and can we afford it.

In our current system we have private insurance, Medicare (for those over 65) and Medicaid (for the poor).  The Bush Administration expanded Medicare to include drug coverage.  Why not just expand the current programs to include everyone?  A single-payer, national health-insurance system.

For one thing, the current programs don’t work–at least not without private pay subsidizing.  Many doctors won’t accept the government programs because of all the red tape and poor reimbursement.  Primary-care physicians and hospitals find it hard to break even. Administration costs to collect payment are often as much as the reimbursement.

So how do providers who accept these programs cope?  The same way they’re able to provide for those unable to pay anything: by raising fees to private-pay patients, of course.

But private-pay and insurance costs are going through the roof.  Employers are finding the costs of health insurance for employees unacceptable.  Employees and the self-employed can’t pay the hefty premium alone.  My own health insurance is over $1,000 per month for my wife and me, and I have a $7,500 deductible.  Many find they can’t get private insurance at any cost.

So, if the Obama administration can actually find money for this unbelievably expensive and complex program, they will have to reign in costs somehow.  This involves cutting provider reimbursement, limiting the ordering–and patients demanding–of costly procedures, and then money to administrate all of this.  Medical liability insurance reform should be considered but is probably a pipe dream.

Where is an example of our government ever performing more efficiently that the private sector? Good luck and God help us all.

Please join our debate.

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21 Responses to “Universal health-care debate: why vs. costs — a doctor’s opinion”

  1. Steve Parker, M.D. Says:

    “God help us all” is right!

    The feds seem intent on taking over banking, finance, much of the insurance industry (e.g, AIG), and the mortgage industry. I’m hoping the current economic worries and huge budget deficits will keep the politicians OUT of the healthcare and health insurance sectors for a few more years.

    There’s lots of money to be saved by wringing out fraud, waste, and inefficiency. But there’s no political will to do so, yet. The U.S. medical liability insurance climate is but one example of fraud, waste, and inefficiency.

    As Ronald Reagan said, “Government is not the solution to the problem; government IS the problem.”

    -Steve

    Steve Parker, M.D.s last blog post..If Dark Chocolate Is Healthy, What’s The Right Dose?

  2. Mark Says:

    Steve Parker makes some great points!

  3. cathy Says:

    So conflicted on this one. This article makes good points. I also think that Steve Parker has good points. It will be interesting to see how this all plays out in the coming years.

    cathys last blog post..Friday Link Love

  4. James Hubbard, M.D., M.P.H. Says:

    Thanks Steve, Mark and Cathy,

    This is going to be a complicated one. Obama puts health reform high on his agenda. We will see.

  5. Sagan Says:

    Tough situation… I expect it will be quite a while before everything’s resolved, though!

    Sagans last blog post..Life Lessons: Skating and Sugar

  6. Dr. J Says:

    “There’s lots of money to be ‘found’ by wringing out fraud, waste, and inefficiency.”

    I agree with that!

    As for universal health care, etc. If people took better care of their health, with decent diets and exercise, there might be a chance for it, otherwise, in my opinion, it will never happen. The costs will bankrupt us.

    Dr. Js last blog post..Nibbles: More Americans obese than overweight, peanut butter may be cause of salmonella outbreak and stats on vegetarian kids

  7. James Hubbard, M.D., M.P.H. Says:

    Sagan, there is really no way of predicting it exactly, at this point. I thought we were going to get Hilarycare in the 90′s.

  8. James Hubbard, M.D., M.P.H. Says:

    Dr. J, the U.S. is already bankrupt, except they can manufacture money. I don’t know. I think it is possible there will just be more mandates, rules and edicts until the care gets so poor, everyone will say, “governement take over and help us”. Kind of like the high risk home mortgage debacle.

  9. James Hubbard, M.D., M.P.H. Says:

    Thanks Mark

  10. Shantil Says:

    This is an informative and great piece!

  11. James Hubbard Says:

    Steve,

    Have you ever known the government to cut waste, fraud and increase efficiency?

  12. James Hubbard Says:

    Thanks Mark

  13. James Hubbard Says:

    Cathy, time will tell. I thought Hilarycare was a done deal in the 90′s.

  14. James Hubbard Says:

    Sagan, don’t know. Obama puts it at top of his agenda. We’ll probably learn more at the State of the Union Address.

  15. James Hubbard Says:

    Dr. J,
    If the U.S. were a business, it would already be bankrupt, but government can print money. We’ll see.

    I predict more rules, regulations and edicts from government until health care is so stressed the government will come in and “save us”, not unlike the high risk home mortgage crisis.

  16. Brandon Betancourt Says:

    Great piece Dr. Hubbard. One of the arguments I always try to bring up in these discussions about healthcare reform is addressing the challenges doctors are currently facing; particularly primary care providers. They are overworked, poorly reimbursed and bare a large part of the responsibility of patient care. Consequently, less young people are enrolling in primary care, which is going to lead to patient access problems.

    I do disagree however with your statement: “So how do providers who accept these programs cope? The same way they’re able to provide for those unable to pay anything: by raising fees to private-pay patients, of course.”

    To my knowledge, doctors who accept private insurances are not able to raise prices for services in order to offset for the financial burden of treating patients that are enrolled in government assistant programs. Assuming a doctor is in-network with an insurance plan, they must accept the reimbursement that the plan assigns. In other words, doctors that are part of let’s say BCBS or United Healthcare network will be paid according to the plan’s fee schedule. In some cases, one may bill the patient for whatever the insurance plan does not cover, but generally, doctors accept insurance assignments.

    So even though a doctor can increase prices, she will be reimbursed according to the assigned fee schedule.

  17. James Hubbard, M.D., M.P.H. Says:

    Thanks for the insightful comments Brandon.

    You are correct. Insurances make doctors take whatever the insurance is willing to offer.

    I guess the point I was trying to make is we make very little profit with the medicare/medicaid programs. If universal health care were to take on this model, as it stands, most health care providers would go broke. The only reasons medicare/medicaid fees work now, is that private insurance pays enough to get us by.

    What do you think?
    If you have time, I would love to hear your opinion on today’s post about a medical home.

    thanks

  18. Dr. Bobbs Says:

    Good article.

    Universal health care advocates tell us that people should have health care regardless of their ability to pay. Didn’t we just try to give everyone a loan for a home without any regard for their ability to pay? That well-intentioned but mindless experiment led to the current economic collapse we are experiencing.

    Even the editor-in-chief of the New England Journal of Medicine, Dr. Marcia Angell, seems to have no understanding of basic economics:

    “Our health care system is based on the premise that health care is a commodity like VCRs or computers and that it should be distributed according to the ability to pay in the same way that consumer goods are. That’s not what health care should be. Health care is a need; it’s not a commodity, and it should be distributed according to need.”

    Since when are “commodity” and “need” mututally exclusive concepts? As a matter of fact, they are virtually synonymous. Unfortunately, being a person of good will with only the highest of humanitarian values in mind does not exempt one from economic reality.

  19. Dan Says:

    Our Health Care System

    The following are facts that are believed to exist regarding the present U.S. Health Care System. This may be why about 80 percent of U.S. citizens understandably want our health care system overhauled desperately due to the inadequate health care they receive and access:
    The U.S. is ranked number 42 related to life expectancy and infant mortality, which is rather low.
    However, the U.S. is ranked number one in the world for spending the most for health care- as well as being number one for those with chronic diseases. About 125 million people have such diseases. This is about 70 percent of the Medicare budget that is spent treating these terrible illnesses. Health Care costs are now well over 2 trillion dollars of our gross domestic product. This is three times the amount nearly 20 years ago- and 8 times the amount it was about 30 years ago. Most is spent with medical institutions, as far as health expenditures are concerned. One third of that amount is nothing more than administrative toxic waste that does not involve the restoration of the health of others. This illustrates how absurd the U.S. Health Care System is presently. Nearly 7000 dollars is spent on every citizen for health care every year, and that, too, is more than anyone else in the world.
    We have around 50 million citizens without any health insurance, which may cause about 20 thousand deaths per year. This includes millions of children without health care, which is added to the planned or implemented cuts in the government SCHIP program for children, which alone covers about 7 million kids.
    Our children.
    Nearly half of the states in the U.S. are planning on or have made cuts to Medicaid, which covers about 60 million people, and those on Medicaid are in need of this coverage is largely due to unemployment. With these Medicaid cuts, over a million people will lose their health care coverage and benefits to a damaging degree.
    About 70 percent of citizens have some form of health insurance, and the premiums for their insurance have increased nearly 90 percent in the past 8 years. About 45 percent of health care is provided by our government- which is predicted to experience a severe financial crisis in the near future with some government health care programs, it has been reported. Most doctors want a single payer health care system, which would save about 400 billion dollars a year- about 20 percent less than what we are paying now. The American College of Physicians, second in size only to the American Medical Association, supports a single payer health care system. The AMA, historically opposed to a single payer health care system, has close to half of its members in favor of this system. Less than a third of all physicians are members of the AMA, according to others.
    Our health care we offer citizens is the present system is sort of a hybrid of a national and private health care system that has obviously mutated to a degree that is incapable of being fully functional due to perhaps copious amounts and levels of individual and legal entities.
    Health Care must be the priority immediately by the new administration and congress. Challenges include the 700 billion dollars that have been pledged with the financial bailout that will occur, since the proposed health care plan of the next administration is projected to cost over a trillion dollars within the first year or so of the proposed plan to recalibrate health care for all of us in the U.S. Yet considering the hundreds of billions of dollars that are speculated to be saved with a reform of the country’s health care system, health policy analysts should not be greatly concerned on the steakholders who may be affected by this reform of our health care system that is desperately needed. Tom Daschle leads this Transition’s Health Policy Team. And we also have Ed Kennedy, the committee chair and a prolific legislator. So if the right people have been selected for this reforming team, the urgency and priority regarding our nation’s health care needs should be rather overt to the country’s citizens.
    Half of all patients do not receive proper treatment to restore their health, it has been stated. Medical errors desperately need to be reduced as well, it has been reported, which should be addressed as well.
    It is estimated that the U.S. needs presently tens of thousands more primary care physicians to fully satisfy the necessities of those members of the public health. This specialty makes nearly 100 thousand less in income compared with other physician specialties, yet they are and have been the backbone of the U.S. health care system. PCPs manage the chronically ill patients, who would benefit the most from the much needed coordination and continuity of care that PCPs historically have strived to provide for them. Nearly have of the population has at least one chronic illness- with many of those having more than one of these types of illnesses. A good portion of these very ill patients have numerous illnesses that are chronic, and this is responsible for well over 50 percent of the entire Medicare budget.
    The shortage of primary care physicians is due to numerous variables, such as administrative hassles that are quite vexing for these doctors, along with ever increasing patient loads complicated by the progressively increasing cost to provide care for their patients. Many PCPs are retiring early, and most medical school graduates do not strive to become this specialty for obvious reasons. In fact, the number entering family practice residencies has decreased by half over the past decade or so. PCPs also have extensive student loans from their training to complicate their rather excessive workloads as caregivers.
    Yet if primary care physicians were increased in number with the populations they serve and are dedicated to their welfare. Studies have shown that mortality rates would decrease due to increased patient outcomes if this increase were to occur. This specialty would also optimize preventative care more for their patients. Studies have also shown that, if enough PCPs are practicing in a given geographical area, hospital admissions are decreased, as well as visits to emergency rooms. This is due to the ideal continuity in health care these PCPs provide if they are numbered correctly to treat and restore others. Also, the quality improves, as well as the outcomes for their patients. Most importantly, the quality of life for their patients is much improved if there are enough PCPs to handle the overwhelming load of responsibility they presently have due to this shortage of their specialty that is suppose to increase in the years to come. The American College of Physicians believes that a patient centered national health care workforce policy is needed to address these issues that would ideally restructure the payment policies that exist presently with primary care physicians.
    Further vexing is that it is quite apparent that we have some greedy health care corporations that take advantage of our health care system. Over a billion dollars was recovered for Medicare and Medicaid fraud last year through settlements paid to the department of Justice because some organizations who deliberately ripped off taxpayers. These are the taxpayers in the U.S. who have a fragmented health care system with substantial components and different levels of government- composed of several legal entities and individuals, which has resulted in medical anarchy, so it seems.
    Thanks to various corporations infecting our Health Care System in the United States, the following variables sum up this system as it exists today. Perhaps the United States National Health Insurance Act (H.R. 676) is the best solution to meet our health care needs as citizens, it appears. We would finally have, as with most other countries, a Universal Health Care system that will allow free choice of doctors and hospitals, potentially, and health care for all completely. It should and likely will be funded by a combination of payroll taxes and general tax revenue which is realistically possible. Because the following needs to be corrected regarding the U.S. Health Care System:
    Access- citizens do not have the right or ability to make use of this system as we should.
    Efficiency- this system strives on creating much waste and expense as it possibly can.
    Quality- the standard of excellence we deserve as citizens with our health care is missing in action.
    Sustainability- We as citizens cannot continue to keep our health care system in as it is designed at this time- as it exists today.
    http://www.mckinsey.com/mgi/publications/US_healthcare/index.asp
    Dan Abshear

  20. Todd Says:

    Here’s a weird idea. What if we had a National Healthcare System that functioned similar to our National Delivery System (the United States Postal Service)? What I mean is have a system that is government subsidized but also privately funded.

    We all know it costs less than a buck to mail a letter at the Post office. However, take a letter down to your local FedEx, UPS or DHL delivery center and see what that costs. Obviously, that cost will be quite a lot more. The very existence of the USPS keeps the private delivery companies from charging 10x what they re right now. The inefficiency of the USPS allows private delivery companies to “fill the gaps”.

    In the authors original post he says he is paying approximately $1,000 a month for his wife and himself. What if he had the option of paying $500 a month for his wife and him? Through a government subsidized universal health insurance system he would save $6,000 a year (that would also become additional taxable income). But, $6,000 a year in savings. That’s pretty great. The other $6,000 would go to fund the government-run program. His $6,000 a year in savings could be used to purchase any gap insurance he thought he needed for his family or buy a new American-made car.

    It’s just not logical to keep the same current system – where American businesses need to ship jobs overseas to countries where there citizens are included in part of their own national UHS. It’s really a no-brainer.

  21. Teresa Says:

    Don’t we already have a form of socialized medicine in this country? When more than half of the country is on some sort of subsidized program, ie. Medicare or Medicaid, this seems like a socialized program to me.

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