In 2018, Americans paid $35 trillion on health care. That works out to be a bit over $10,000 for every resident of the USA.
Apart from Switzerland, which paid about $8,000, and Norway, which paid $6,600 per person (countries with better care than the USA), all other major Western and far Eastern democracies paid under $6,000 per person. Each of these other countries offers a form of universal coverage, and most have significantly higher life expectancies than we do.
Keeping the status quo will needlessly cost our economy at least $14 trillion ($4,000 per person) per year, over building a new system from the ground up. No one has all of the answers, but every American should agree that drastic action is overdue.
The current system is rife with mismanagement and fraud. There are over 2 million insurance claims processors, many of whom are paid to deny claims for needy patients. Lobbyists are fattening the wallets of industry shareholders at the expense of regular people.
Here are some recommendations that can be considered.
1) Set up a universal health care management system, with a company such as Google or Amazon in charge. This is a straightforward application for them. Having universal health records at one organization would not only be secure and efficient but would also enhance medical research capabilities.
The federal government is incapable of doing this properly. After all, it sent 1 million stimulus checks to deceased people and Medicare is rife with fraud and waste.
Ironically, on the July 12 “Fareed Zakaria GPS” program on CNN, University of Pennsylvania professor Ezekiel Emanuel cited a centrally administered health administration system, and he even mentioned it being run by Google, could have saved many lives in the COVID-19 pandemic. This shortcoming makes the U.S.’ capability at or near the bottom among all Western and far East democracies when it comes to future pandemics.
2) Develop a single-payer system run by the management organization but paid by the federal government. Each condition would have a code that falls into categories: A) Mandatory universal coverage or B) Optional coverage, with the latter reserved for “heroic measures.”
The optional codes are not covered unless you have private insurance over and above the universal coverage, and your insurance company covers that optional code. Payment by code is negotiated between a provider union and the federal government for mandatory coverage and between provider union and the insurance company for optional coverage.
3) A strong audit program would be established by the federal government to ensure codes are not abused by providers.
4) Pharmaceuticals and devices would have pricing negotiated between industry and the federal government. Companies whose products come off patent should receive 20% of its pre-patent price from generic makers to offset lower pricing that would occur from the price negotiations.
5) Pharmaceutical companies that follow all Food and Drug Administration rules in gaining federal approval for their product, commit no fraud in development and are not guilty of errors in quality control or side-effects accounting will be exempt from lawsuits accusing the company of damage. Such issues will be brought before a panel of judges and damages would be paid by a fund developed by the industry and federal government.
6) Malpractice lawsuits would be tried before a panel of judges, including a civil judge (ex-officio), an actuary, an industry representative and a patient advocate.
Total restructuring health care would require the desire to break with the totally ineffective status quo. Our health care system is literally killing people and breaking our economy.
If we have the courage to do what is best for the country, and have the nerve to step on some toes that need to be stepped on, we can make our country better and more compassionate, whether we are Republican or Democrat.
Jonathan J. Shuster, PhD, lives in Gainesville.