My Thoughts on Health Care in America and a Single Payer System
These are my own personal opinions and in no way reflect the thoughts or opinions of my employer or colleagues.
A. In my opinion, all Americans should have access to health care. We have some of the best health care providers, hospitals, and technology in the world. The citizens of the United States should all benefit from those resources.
B. A single payer system is a great plan for Americans, but Medicare for all is not the answer. Medicare is not sustainable. Some patients believe that Medicare is free health care. Those patients forget that all taxpayers have paid, or are paying, for those visits, treatments and procedures. A Single payer system must have better checks and balances to prevent overspending.
C. There is currently not enough funding coming in to support the future growth of the Medicare insured population. An improvement is needed to algorithmically determine what tests, treatments, and procedures are medically necessary, and not allow doctors to order numerous and expensive tests. Health care systems such as Kaiser have done a great job at this by practicing preventive medicine while controlling costs but eliminating the overuse of unnecessary tests.
D. Patients currently enrolled in Medicare are able to see multiple doctors and specialists, sometimes multiple specialists for the same problem. A single payer system would start patients at the primary care provider. This would be best accomplished by having more physician extenders such as nurse practitioners. A specialist visit should be limited to those patients who have first seen the primary care provider, have tried and failed conservative treatment, and have had the appropriate workup. Not only would this help control cost, but it would also improve access for patients to see specialists since specialists would have more availability for those patients requiring specialist level care.
E. Healthcare will not be free, but should be free at the point of delivery for emergency care and preventive medicine. To cover the cost of a healthcare plan for all Americans, taxes will have to be raised. Many super rich Americans have commented they would be willing to pay more taxes. It is possible that the billionaires of our country, such as Warren Buffett, Jeff Bezos and Bill Gates, would be willing to pay more in taxes if they knew that those dollars would be earmarked for a particular purpose, such as providing healthcare to Americans. As large corporations employ millions of Americans, and many pay for, or subsidize, their employees healthcare, a higher corporate tax would also help fund a single payer program for Americans.
F. As part of a single payer program, a nationwide shared electronic medical record needs to be in place to prevent the unnecessary duplication of tests. Currently, a patient can be seen in one health care system, then present to another provider or health care system, and the previous lab tests and studies may not be accessible. This results in a duplication of tests and wasted costs and healthcare resources. A provider should be able to see the results of your labs, or other tests, to prevent repeating expensive tests simply due to the inability to view the results.
G. We should consider higher copays for non-emergency and non-preventative care. For a one day cough or non-traumatic knee pain, many Americans rush to see the doctor for an expensive exam and potentially other specialized tests. A copay at the door may drive patients to try over the counter treatments first, before seeking out more advanced medical care.
H. While a plan for Universal healthcare is developed, a bill needs to be passed which eliminates the practice of “surprise billing.” A bill should make it illegal for a physician to send a secondary bill to a patient for that physician's care at a hospital, simply because the doctor is working at the hospital but not covered under the insurance plan of the patient. By default, if a physician is working at a hospital, and renders care to patients within that hospital, they should accept the payment agreement that has been worked out with the insurance carrier and other physicians of the same specialty within the hospital.
I. Control the cost of medications. Government run pharmaceutical companies may be able to provide the least expensive generic medications to Americans under the development of a single payer system. Secondary insurance plans may be needed, as is common in other countries, to offset the price of more expensive prescription medicines from other pharmaceutical companies. More specific laws should be in place to prevent the ballooning cost of medications in America.
J. We need to control the costs of implants and other medical devices. Make it mandatory to disclose the costs of implants such as total hip and total knee replacements. Make it transparent to know the cost of stents and pacemakers. Institutions should know what other institutions have paid for the same implants and medical devices. A more standard and structured pricing program would help control the cost of healthcare delivery in the United States.
K. The opioid epidemic needs continued work to improve the problem that has been created. I have read that the United States makes up 5% of the world's population; however, we consume 80% of the worlds’ opioids. We need to continue to not use narcotic pain pills for first line treatment. We need to severely limit the duration of treatment when narcotics are needed and utilized. We need to work on weaning those patients that are on chronic narcotics. We need to educate patients and providers on the role of non-opioid pain control.
L. The obesity epidemic needs to continue to be addressed as a healthcare crisis. We need to modify the mindset of patients and doctors to work first at preventing disease, and not simply waiting until diseases are present to treat them. The obesity epidemic can increase the rates of arthritis, diabetes, hypertension, sleep apnea and disability. By addressing the obesity epidemic more aggressively it will exponentially improve the health status of Americans.
M. Wait times will increase. Other countries do have longer wait times to see the doctor. Elective surgical wait times will be increased as well. Americans need to understand that under a single payer system, that it may require a longer period of time to get in to see the doctor or have surgery when it is not emergent.
N. Do not reinvent the wheel. It would be prudent to look at Kaiser and other similar health systems that have done well at being preventive and cost efficient when it comes to rendering healthcare in America. Bringing non-government insurers, health care executives and health care providers together is the only way to develop a comprehensive single payer health care plan for all Americans.
Adam S. Rosen, DO
March 2019
