I was listening to a Senate hearing this week on Medicare for All, a proposal that has been circulating for several years now. This proposal makes the case for “single-payer” health care – just like how Medicare pays for eligible beneficiaries now – for all Americans, regardless of age.
Arguments supporting this model suggest that it is more equitable and would result in both administrative savings and better health outcomes for all Americans. Arguments against this model suggest that government shouldn’t be in charge of anything and innovation would be stifled and many care providers would leave because of low reimbursement rates.
Straw Man Health Care
I suggest that the cost of health care isn’t the real issue here. Don’t get me wrong, it is a factor, but it is not THE factor. The real question here is do you have a right to be healthy? To answer that question, you need to have a concept of what “healthy” is.
Our current system of “health care” is designed to treat illness and injury. Patch up the things that go wrong and return you to working order. The underlying system, and core belief of that system, is that the absence of illness or injury means you are healthy and the presence of injury or illness means you are sick. This is where the problem lies.
How do you define “healthy”? Turns out, that isn’t an easy thing to do because there are so many different factors that come into play. For some people, “healthy” is a state of mind; an attitude. For others, it is a goal that may include losing weight, increasing stamina, sleeping through the night or not having dark thoughts and wanting to die.
Most of us don’t actively seek out health care providers as long as we are “healthy”. And if we’re honest, when we do it is because we are overly influenced by pharmaceutical ads on TV, disease chat rooms, and conversations with people who never attended health class much less went to and graduated from med school, who plant ideas in our heads about what might explain an ache or a pain.
When Something Is Wrong
When something is wrong, though, we not only seek out information and treatment, we demand it! And we have expectations that, in spite of our daily choices around nutrition, exercise, substance ingestion, and sleep, the health care industry will have a fix for what ails us.
What makes health care different from, say, plumbing, is that we are talking about a life. A person who lives, loves, irritates, and/or soothes others. Someone who is loved by others. Someone who feeds strays or tends a beautiful garden. Someone who may be essential in the lives of children and older adults, who may be the inventor of the Next Big Thing, or a poet or composer whose works will last for centuries.
We value life more than we value, say plumbing. So, when something does go wrong, there is a greater incentive to return that someone to his or her previous levels of functioning. You can’t just get a new someone or order a replacement on Amazon.
A Different Proposition
What if we assume that we are all deserving of being healthy? What if we changed the health care delivery system and loaded the front end (prevention), rather than scaffolded the back end (end of life care)? This would require a massive re-working of every element in the system, but it can be done!
First and foremost, it would require that each of us take responsibility for our own health and develop a true partnership with health care providers who would see us from conception to end of life. That is a lot to ask, I know.
Preventative Care Models
Good news! We are already doing this in other areas of our lives. We wear seat belts in our cars. We use smoke alarms in our homes. We have agencies that test water quality and insure that our food sources are free from poisons. We have other agencies that conduct research and provide information so that we can make informed choices about things. All of which prevents harm and keeps us safe.
And we are doing this in some areas of health care. Medicare pays for an annual wellness visit. This visit is ALL about prevention. With the right information, your health care providers can make really accurate predictions about what might happen to you based on the life choices you are making and the stressors you are living with. And help you come up with a plan to address this and connect you with resources to support you in achieving your goals.
It Is about Choice
Some people argue that universal health care limits your choices. My experience, as a Medicare provider for my entire professional career, was that there were far more choices for folks who used original Medicare than those who went with Medicare Advantage (MA) plans. MA plans determine not only who you can see, but how frequently you can see them!
I prefer to make my choices based on relationships. If I have developed a relationship with a physician or advanced practice provider and have a preferred specialist I like, I want to be able to stick with him or her, not based on my monthly premium, but based on how well we work together to keep me healthy.
The Elephant in the Room: Who Pays?
From a purely fiscal view, costs for providing health care are astronomical here in the United States. Yet, compared with other developed nations, we get less bang for our buck. One of the folks testifying at this Senate hearing pointed out that 33 cents of every health care dollar goes to administrative costs – not to supplies or salaries – but to billing for services.
End of life costs are a good example. Too many older adults who have complicated, chronic (never getting better) conditions, enter the hospital and are poked, prodded, injected, and vented, only to be removed from life support within a few days because there is no hope of recovery. These procedures all have their own fee determined and agreed upon by Congress, who ultimately sets reimbursement rates.
I am not suggesting that these procedures should be denied (although, under certain insurance plans they are!); rather I am suggesting that if we had a different definition of healthy, we might approach our death differently. We might be able to prevent some of the pain and suffering or change the intensity and frequency of symptoms, resulting in a better death.
Medicare for All
The financial projections for funding Medicare are dire, but only if we continue to pay for health care the way it is currently structured. The current model incentivizes billing for more services rather than billing for better outcomes.
I am a firm proponent of Medicare for All. I believe it benefits not just patients, but the entire health care industry. It will require a fundamental change in attitude about what we expect from health care providers, be they professional care givers or neurosurgeons. It will require that individually we become responsible for aspects of our lives that we can control and learn to partner with others trained in specialties to support wellness. It will require that we confront an insurance behemoth that is binging on the fears and follies of its beneficiaries and Congress like some addict on opioids.
We need to take back our ownership of what it means to be healthy and see that all of us have access to the services and care we need. The outcome of doing this is a healthier America.