Ask the Right Questions about Healthcare

By Wayne Caswell, Founder of Modern Health Talk

Politicians Need to Ask the Right Questions about Healthcare

In Healthcare: Mandatory Coverage or Universal Access?, Dr. Josh Luke presents one perspective – that of a hospital CEO. Readers should know that he represents the medical industrial complex, which also includes insurers, drug companies, equipment providers, and testing companies. Their collective interest is to protect the perverse profits that come from illness and injury, and the fee-for-service incentives that encourage ongoing treatment of symptoms. I found Dr. Lukes’ framing of the healthcare issue too partisan, so I added a response that forms the basis of today’s post.

What’s the DIFFERENCE between Universal Healthcare and Universal Access? Republican politicians have promoted Universal Access, confusing it with Universal Healthcare. Access, however, only means you can get health care if you can afford it. That’s like having the ability to buy a luxury yacht or summer home, but only if you have enough money to afford it. Progressives instead want Universal Healthcare, a concept I endorse here at Modern Health Talk. It’s efficient and what other advanced nations have. So let’s reframe the issue by asking different questions. 

Is BASIC Healthcare a Right, or is it a  privilege and personal responsibility? This is a good starting point, because The Preamble to The Declaration of Independence says…

We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.

How much health care should GOVERNMENT (taxpayers) provide, and how much is an individual’s responsibility? This too is a good question, because Congress keeps tinkering around the edges of how to PAY for care through health insurance, and Dr. Luke’s article is no different. If we say government should pay nothing, then how do we prevent disease and pandemics if some people can’t afford immunizations and preventive care? Living in gated and quarantined communities is not a solution, because disease can propagate through air & water or from insects & animals? Public health officials understand that and have entirely different perspectives than that of hospital administrators or large medical corporations. They hold another truth to be self-evident, that…

An Ounce of prevention is worth a Pound of cure. (Benjamin Franklin)

How should we PAY for healthcare? Conservatives would have you believe they’re being fiscally responsible, but their political aim seems to be more about maximizing industry profits than reducing overall costs and developing a healthy & productive workforce. Meanwhile, their strategy of replacing the Affordable Care Act (ACA) with the American Health Care Act (AHCA) would have resulted in huge tax cuts for wealthy elites while leaving tens of millions without health care because they can’t afford it.

Why should healthy people pay ANYTHING for unhealthy people? This is the moral dilemma of health care. Some people oppose universal healthcare because they don’t want public help of any form to go to people who don’t work hard enough, don’t have enough determination, don’t make enough money, or are just “Losers” and don’t deserve it. It’s one thing for them to say they make good lifestyle decisions and others make bad decisions, but good decision-making is just one factor that determines their health. Luck also plays a role, and that’s why we have insurance — to spread the risk.

How much FOCUS should government put on prevention? I’m with Ben Franklin, often writing about the pillars of health & wellness: nutrition, exercise, and sleep? That’s why I urge everyone to watch the “must see” documentary, Escape Fire: The Fight to Rescue America’s Healthcare. It can be described as An Inconvenient Truth for the healthcare debate. I’m also working on a white paper, The Economic Benefits of Population Sleep Wellness, where I’ve so far estimated savings of up to $1 trillion/year from good sleep improving health, safety and performance. It will also suggest various public- and private-sector programs to improve sleep.

What PERSPECTIVES are most important? Politicians can’t be expected to understand all the nuances of the complex healthcare industry. They will naturally seek guidance from industry experts, and that’s natural. But problems occur when other perspectives are ignored or discounted. I give “We The People” (consumers, patients & voters) the highest priority in developing healthcare policy, followed by individual practitioners (docs & nurses), public health officials (who function as public servants and have no profit motive), and finally the medical industrial complex (large insurers, hospitals, drug companies, testing companies, and equipment providers).

What should be the OBJECTIVE of healthcare policy? Is it to serve The People and contribute to a healthy and productive workforce that drives the economy and global competition, or is it to maximize industry profits? We know what it SHOULD be, and I think we also know reality. an aging population,

How does the U.S. compare with other advanced nations in the OECD? Many sources, including the United Nations and World Health Organization, report that Americans pay about twice as much but still live sicker and die younger. Our reliance on employer-provided and private insurance is the primary cause, or at least a major contributor.

Where’s the TRANSPARENCY? We may take great pride in free-market capitalism, but how can we expect people to shop for the best value in healthcare when hospitals keep their charges secret? Even if price transparency gave them the ability to compare options for common procedures, they’re unable to do so in emergencies when they’re unconscious or in severe pain. Capitalism just doesn’t work in healthcare, or at least not all the time.

HOW BAD is the Affordable Care Act? Despite what you hear from conservative sources, the Affordable Care Act (Obamacare) made significant progress toward improving the accessibility, affordability, and quality of health care. Yes, it’s far from perfect, but we must be careful with what replaces it. The uninsured rate declined by 43% after the ACA became law (from 16.0% in 2010 to 9.1% in 2015). And the cost curve was flattened to the lowest annual increase in decades. But still, overall costs have not been reduced. That’s for many reasons, including (1) an aging population, (2) special interest lobbying to protect industry revenues & profit, (3) incentives that are misaligned with goals, and (4) an insurance middleman that adds more cost than value.

What about the REPUBLICAN plan? Is there one? Republicans have long wanted to repeal Obamacare, but dozens of attempts have failed so far, including Trump’s American Health Care Act. According to the bipartisan Government Budget Office (GBO), tens of millions of Americans would have lost their insurance under that plan, because they’d be unable to afford it, and, tens of thousands of them would then die needlessly. So it’s no surprise that 85% of voters were angrily against it and wanted their representatives to instead fix ACA problems. Isn’t it time that politicians find ways to reduce the need for health care in the first place through WELLNESS programs? Isn’t it time to focus less on shifting the funding burden and more on lowering overall costs? That could be done with disruptive business models and innovative technologies, given enough political will.

Fixing U.S. Healthcare

With the right objectives, questions, and policies, we “should” be able to cut costs in half by curing our healthcare system’s cancer rather than just treating its symptoms. That would save over $2 trillion/year, which could then be invested elsewhere. But will politicians have the COURAGE to stand up to industry lobbyists who already spend three times as much as the military industrial complex to avoid losing that revenue? Given the high ROI of political investments, I think they could justify spending a trillion in one election cycle to avoid annual revenue cuts.

UPDATE: The medical-industrial complex reportedly has spent $5.36 billion since 1998 lobbying in Washington. That’s even larger than the $1.53 billion spent by the defense and aerospace industries and the $1.3 billion spent by the oil and gas corporations over the same period.

As a futurist, I consider different scenarios, as well as drivers and inhibitors. I’m guardedly optimistic about the future of healthcare, because the opportunity and public awareness is so great. On the other hand, I worry about the politics, and that’s why my writing often gets political.

Universal Healthcare Justification

COSTS — Sure, some people will rile against a single-payer healthcare system as too much government bureaucracy. But it has been proven over and over to cost less overall than employer-provided or private insurance. Medicare is a good example. It comes out far ahead of the 2nd most efficient insurer, Aetna. According to Steven Brill, Medicare’s administration and management cost of processing over one billion claims a year is less than $3.80 and in some cases as low as $0.84. Aetna’s cost of processing its 229 million claims is much higher at about $30. That efficiency is why so many people have called for Medicare as a public option, leading to Medicare-for-All.

BENEFITS — Public health officials know about the prevention benefits of universal healthcare, immunization, clean drinking water, and public education programs. But other benefits include greater workplace productivity, which translates into improved profits, GDP, global competitiveness, and even national security. We need healthy soldiers, don’t we?

Isn’t Medicare an Entitlement?

No, not really. Conservatives ideologically hate entitlements, but Medicare is something that people pay for. It’s not something given to them. The same goes for Social Security. Seniors of retirement age paid into Social Security their entire lives, and they now pay for Medicare through deductions from their Social Security checks.

As a fee-based public health program offering basic services, Medicare is considerably more efficient than any private insurance company. There’s no profit motive. If basic Medicare were offered universally or as a public option, and people wanted more coverage options, they could always spend more for Advantage or Supplement programs. Is the only argument against this a perceived need to protect insurance company profits? How is that justified?

But what about people who can’t afford Medicare premiums? They may have no income if they’re in school, are in between jobs, have a temporary or permanent disability, etc.? What government help might they get until they’re back on their feet? I wrote two articles relating to that issue. One is on Universal Healthcare opposition, and the other is about the eventual need for social programs for the long-term unemployed as automation replaces jobs faster than creating new ones. The United Nations recently warned nations to prepare now, because that day is coming sooner than most people realize. They floated the concept of Universal/Unconditional Basic Income.

Telehealth and Remote Monitoring Technologies

I see a very strong future for telehealth companies and doom for those who resist. That’s because telemedicine improves employee health, lowers healthcare costs, reduces absenteeism, eliminates the need to take time off for doctor visits, and improves overall worker productivity. All of that contributes to employer’s bottom line, so it’s not surprising that more companies are supporting telehealth services, just as they supported in-facility services.

The COVID-19 pandemic increased public awareness of telehealth benefits and helped propel its popularity. Before then, protectionist lobbying and legislation intentionally discredited telehealth over concerns of patient safety. But now telehealth is even extending across state lines and may eventually extend across international borders too, giving patients 24×7 access.

Telehealth and private pay are trends that are partly driven by more consumers opting into high-deductible insurance policies and taking responsibility for their health maintenance costs. Patients are becoming more aware of the need to make healthy lifestyle changes and are seeking better value in health care. They’re also demanding that hospitals open up their once-secret charging system so they know ahead of time what procedures will cost and can actually comparison shop. All of this fuels my telehealth optimism.

Free-Market Capitalism Doesn’t Work in Healthcare

The ACA introduced new competition among insurers on a government website, in exchange for a mandate that everyone have insurance. The idea was to prevent them from cherry-picking healthy clients and denying coverage to others. It required 80% of their premiums to actually go to providing care and had other requirements too, some of which caused insurers to stress low-cost, high-deductible policies. The objective here was to encourage consumers to live healthier lifestyles and comparison shop for the best value needed care, but it didn’t work.

Comparison-shopping is only possible for savvy consumers with price transparency and vibrant competition among alternative providers. It completely fails when the patient is unconscious, in severe pain, or there’s some other emergency. That’s why other nations control prices, whether they have government insurance or private. We don’t pause the ambulance while we search online for the best trauma center value, now do we?

Consumers, as savvy as they may seem, don’t have enough medical knowledge to make smart decisions about their care options. That’s why every other rich nation shops and negotiates on their behalf. The U.S. is the only nation, for example, that allows direct-to-consumer TV advertising of prescription drugs.