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So the system, either an ACA-like solution with Individual Mandates, a Single Payer/Medicare for All, or a Single
Payer based upon a non-Medicare entity, will be the result of considering the questions in this section. It would seem, at least to me, the current, fragmented system of payment for health care is too complicated, confusing, and opaque to support universal health coverage.
SOME SPECIAL CONSIDERATIONS
As we think through the options, there are at least two other important factors that need be pointed out:
Are we doing all we can upstream to prevent the need for more
less on health care and arguably have healthier populations. But education, affordable housing, easier access to healthy foods,
that looking at the gap in health care expenditures is not a valid measurement. “When you add together health and social spending across countries, the United States is no longer a major outlier when it comes to per capita costs spent on factors promoting health.” Further, “many other countries have encouraged smarter public and private investments into factors that promote health...rather than spending more overall on health care once people are sick.”6
Are the solutions all about universal coverage and what system(s)
there is going to be ongoing pressure to adopt new diagnostic and therapeutic modalities, to provide care in new ways. These are not necessarily going to be less expensive. Our role as health care clinicians will include the need to progress toward more organization in the United States participated in the Choosing Wisely campaign. While not perfect, this is a model for what we will need to do to be part of a viable health care future.
CONCLUSIONS
There are many questions here and it certainly is daunting if we look at the whole, and try to jump to the end result. Hopefully, we can answer questions sequentially, based upon answers that give us some guiding principles:
• How much investment goes into the health care system, and how
It’s time for this rational conversation. The longer we wait, the more ground we’ll need to make up, and the more likely we’ll have an imposed solution that does not respect the needs of all the stakeholders.
So, are universal health coverage and single payers necessary
CONTRIBUTING AUTHOR
■ ALAN GREENGLASS, MD is an Internal Medicine physician. He serves as Executive Medical Director of Christiana Care Quality Partners Accountable Care Organization in Wilmington, Del. and recently retired as the founding CEO of the Ebright/Christiana Care Accountable Care Organization.
REFERENCES
1. Woolhandler S, Himmelstein DU. The relationship of health insurance and mortality: Is lack of insurance deadly? Ann Intern Med. 2017;167:424-431. 2. Institute of Medicine. 2002. Care without Coverage: Too Little, Too Late. Washington, DC: The National Academies Press.
3. Carroll AE, Frakt A. The best health care system in the world: which one would you pick? New York Times. September 18, 2017.
4. Sanders B. Bernie Sanders: Why we need Medicare for all. New York Times. September 13, 2017.
5. Frank RH. Why single-payer health care saves money. New York Times. July 17, 2017.
6. Chen LJ, Weinberg M. The Sanders single-payer plan is no miracle cure. New York Times. September 19, 2017.
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