At my school "Behavioral Sciences" is a loose term applied to several disciplines including human development, abnormal psychology, biostatistics, epidemiology, clinical ethics, and health systems. Recently we spent all of four days discussing the health care system in the United States along with a few comparative examples from other countries including Canada, Switzerland, Germany, United Kingdom, and Japan. Apparently eight hours of lecture about a system so complex as the US model is all the time we future physicians get. Not surprisingly, our system is the worst.
On the final day of lecture we spent one hour discussing the Patient Protection and Affordable Care Act, i.e. Obama's Plan. Some of the reforms discussed in class are good ideas - for those of us lucky enough to be insured, no denial of coverage due to preexisting conditions is a great thing. So is no recision of coverage. So is a cap on co-payments and out-of-pocket payments. If you're on Medicare and living in the Donut Hole of Big Pharma, you're still screwed. Sure, you get a 50% discount...so you'll stay right there, in the Donut Hole, for twice as long. You'll spend the same amount of money that you don't have to spend. If you're uninsured the state in which you reside is supposed to set up affordable exchanges so that you can purchase your own insurance. Some of these ideas are well founded and advantageous, but I think we've lost the plot.
I am a lowly medical student; but if you ask me, the place to start is at the bottom.
The Basics:
Physicians supply medical care. Why does what they do cost so much? By the end of my schooling, my loans will be a quarter of a million dollars not including interest. Let's call it closer to 300,000.00 by the time I pay some interest. It takes most physicians 15 to 20 years to pay off their debt. If going to school to be a doctor was less expensive, we wouldn't have to charge so much. Granted, some may still charge exorbitant fees, but that's where the government gets to cap prices. Make school cost less, decrease fees. Regulate state-funded medical schools and put a cap on tuition. Medical schools don't need that much money anyway. What supplies do we use? The internet, a few scalpels if you're lucky, the library and a coffee shop. That shouldn't be too expensive. Oh, you might have to cut administration fees. If physicians still charge too much, then let's just pay them negotiated fee-for-service like they do in Germany. Physicians love to get paid for every procedure they do, so let them keep that, just contract with the government on what each service can cost. How do we pay for hospitals - the government sets a budget and the hospital lives within that budget. Hospitals can compete for the rich who have bought Supplemental Insurance (see below).
Almost every doctor is a specialist or sub-specialist and there are no GPs left on the front lines. How do we fix that? Obama is trying by offering a 10% increase to physicians practicing family medicine in an area of scarcity. How about this to keep costs down: since a doctor's school is now heavily subsidized by the government, or even free, require that all newly inked physicians spend two years in a Federal placement practicing family medicine. Continuity can be ensured by providing physicians who stay on that 10% increase. Even if that's not your intended specialty, the time fresh out of school is before you've decided your route, before you've Matched to a residency. It's the perfect introduction to health care and it serves a great need. It's like Teach for America, only let's call it Health for America, or Doctors Within Borders.
Insurance companies drag us over the coals with skyrocketing premiums and unfulfilled claims. How to prevent this? Hmm, how about some Federal REGULATION? In Switzerland, insurance companies are required to be non-profit. Amazing! If insurance companies want to make more money, they can by selling Supplemental Plans that the rich can buy. That sounds like a great idea, or perhaps we could cap premiums along with co-payments. Perhaps we could start a real Federal Health Plan. People don't have to join -they'll be enrolled when they get their Social Security number at birth. Everyone can have a Personal Insurance Card, like they have in many other countries. The card allows the physician to access the patient's entire medical history while linked up to the national servers. This is how they do it in Taiwan. Everyone pays into it. Medicaid for the masses, paid for by the masses. Everyone is covered and everyone is entitled to walk into a GP of their choice when their throat hurts, or go to the hospital of their choice when something more serious happens. No long waiting times, which is a common complaint from those anti-universal healthcare.
Besides insurance costs and hospital costs (both taken care of now) the other big personal cost is pharmaceuticals. Well, watch out Pfizer, regulation is coming to your house! The only way we can guarantee access to life-saving and quality-of-life-improving drugs is by ensuring costs are affordable for all. This means a Federally imposed set of regulations on prices. Big Pharma complains that they won't be able to do any more R&D if we regulate their spending. To this I say bollocks! Big Pharma will always do R&D because it will always be in their interest to come up with new magic bullets. Perhaps which avenues they explore could be encouraged or punished via incentives and regulations, i.e. we really don't need any more Viagra, but we could use some multi-drug resistant tuberculosis research.
How to pay for this, because it's going to get expensive... a flat percentage income tax might work. Yes, the rich will pay more. But then again, they have more money with which to pay. If you're rich you can think of it this way: all those dirty homeless people you pass on your way to your 50th floor corner office won't be hacking and coughing all over you anymore! In the end, it serves your own health better to take care of everyone else's. And no, you cannot opt out. All of this money should be collected into one source, located Federally. The money needed to keep the system going comes from taxes. Yes, taxes! "Tax" is not a dirty word, it is the only way to universal healthcare. The Germans undertake "Concerted Action" twice a year in which employers, unions, doctors, hospitals, government [and insurance companies] meet to set fees by which all will abide. That sounds like a good idea too, and the American people should like that because they'll get a voice in the decision making process.
True universal healthcare in the United States is not possible through a State system. States bicker and have their own lobbyists to satisfy. The Feds need to rise above all this and put together a COMPREHENSIVE plan, that doesn't just plug holes with bubble gum. Our ship is sinking. It needs a complete re-haul before it goes down completely. Other nations across the globe have been providing healthcare to all their citizens for decades. We have the advantageous position to be able to pick and choose different approaches from a multitude of working plans. Let's not reinvent the wheel!
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