Page 20 - Delaware Medical Journal - December 2017
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Universal Health Coverage and a Single Payer System — Necessary Partners?
Alan Greenglass, MD
In the run-up to the passage of the Affordable Care Act (aka ACA, aka Obamacare), an acquaintance told me he didn’t agree with the idea that the government, and indirectly
himself, should have to subsidize people to buy health insurance. I understood his concern, but explained that he, and we, were already paying, and we weren’t getting a very good return on our money.
On an economic and societal level there really isn’t “free health care.” Hospitals are reimbursed for “uncompensated” care, either directly by governments or indirectly through higher payments on the insured. In either case “we” are paying for this through higher taxes and higher insurance premiums.
We are also paying the price of providing high-cost, catastrophic care and of care in inappropriate settings (institutional instead of Department care for uncontrolled hypertension and diabetes, we provide less than optimum care and drive up costs, or at least spend money on recovery from illnesses instead of for keeping people healthy.
And we are also paying a price in the loss of respect and empathy in our society. Yes, some people have themselves to blame for their poor health due to their smoking, substance abuse, or bad driving habits. But for most folks that is not the case. Can we blame the elderly, children of the poor, or those who’ve lost their genetic pre-disposition to heart disease, diabetes, or cancer, or
This article is meant to provide a framework for a discussion about what to do next for the American health care system. based, national conversation starting with the stakeholders most intimate to the issues — the consumers, the “providers,” and those who pay for health care either directly or indirectly.
To have this discussion we need to understand terms, know how other health care systems operate (guess what, there are no “pure” single payer or universal coverage models), suspend disbelief in that today we have room for improvement. This last point is vital. If someone thinks what we’re currently doing is great for all the stakeholders, then there is no need for you to read and discuss further. We’ve heard enough about the 18 percent of our Gross Domestic Product (GDP) the United States spends on health
care and our outcomes for life expectancy, infant mortality, and
burden on clinician practices, the delays or total lack of access
to primary and behavioral health care, the rise in health care expense related bankruptcies, and the stagnation in wages
as more employer resources are directed to health insurance is a feeling of powerlessness, a fear that any change might be keep going and to get involved.
SHOULD WE HAVE UNIVERSAL HEALTH COVERAGE?
the country has affordable access to health care. But really, what
sharing. Will there be co-payments, deductibles, or annual and/or
As we make our decisions we’ll want to know what the impact of expanded access to coverage provided by the ACA has accomplished. A recent review authored by Woolhandler
and Himmelstein in the Annals of Internal Medicine1 2
that “health insurance saves lives.” We’ll also want to look
at other countries. Almost every other nation, developed and Many are as good, or surpass those here, especially for less advantaged populations. Is access to health care alone the coverage, how are clinicians and health systems paid, and from where do the funds come (how much from the consumer, from
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Del Med J | December 2017 | Vol. 89 | No. 12
