The Healthcare Crisis: Why responsibly managed Universal Healthcare is the only solution

Although it may come as a surprise to you as I am very conservative, I support responsibly implemented universal healthcare in the United States, and truly believe it is our only option to keep our system from collapsing under its own weight. The fact I am conservative, and support universal healthcare, should give even more credibility to the idea.  As I discussed in the Medicaid expansion article, you cannot afford to miss out on Medicaid, meaning I support the movement, but within reason.  So let’s discuss exactly why I support “socialized” medicine and how we can afford it. 

I should start out by saying I did not and would not support “socialized” healthcare if it wasn’t for the effects of the “Affordable Healthcare Act,” even though its far from affordable.  Obamacare essentially transformed the entire reimbursement system for healthcare services in the United States, making it financially impossible to avoid a completely socialized healthcare system eventually.  Whether you realize it or not, we already have socialized medicine in the United States, and have since at least when I entered the medical field in 2009.  We have programs such as Medicare, Medicaid, the Veterans Administration, Tricare, Indian Health Services, and your local health department.  All of these are either mostly or completely funded by our federal government, via taxation.  Currently Medicare covers 44 million citizens, Medicaid 75 million, Veterans Administration 10 million, 9.5 million through Tricare, and 2.5 million citizens covered under Indian Health services.  All together, these socialized health insurance platforms cover 141 million Americans, representing a whopping 43% of the entire population of the United States!  Since these programs are either completely or almost completely funded by the government, nearly ½ of the general population receive essentially free healthcare, funded by the taxpayer.

Although recipients of our already existing socialized healthcare systems represent just under 50% of the general population, the recipients of these programs make up the majority of payment for healthcare services delivered annually.  The reason for this is simple: Medicare covers those who are 65 or older or disabled, and those over 65 years of age will always require more healthcare services than the young and healthy. This is only going to get even more costly as baby boomers age, and require more healthcare services.  In fact, CMS or the Centers for Medicare and Medicaid Services, which we will discuss further, reports that “Per person personal health care spending for the 65 and older population was $19,098 in 2014, over 5 times higher than spending per child ($3,749) and almost 3 times the spending per working-age person ($7,153).”  Also important, in 2018, total expenditures for both Medicare and Medicaid accounted for 1.35 trillion dollars.  Keep in mind that these are only 2 of the many socialized healthcare platforms and remember the United States only brings in about 3-3.5 trillion dollars in annual revenues, to pay for this 1.35 trillion-dollar annual expenditure. 

Another factor that really needs discussion on this topic is lost productivity on a national level.  This comes in two forms.  The first, is the fact that many Americans have already quit working, or reduced working in order to qualify for Medicaid.  Although it may not have been the intention of the Affordable Care Act, the ACA actually poured gasoline on this raging wildfire by significantly increasing the thresholds for qualification.  This effectively punished many lower to middle class Americans, by doing exactly what was discussed in the previous chapter: forcing them to pay higher private health insurance premiums, while excluding them from Medicaid.  Private insurance became more expensive, and Medicaid became even more enticing for those familiar with the program.  In my decade of experience, and especially since Medicaid expansion, I have lost count of how many patients have entered the clinic and told me they were quitting their job to qualify for Medicaid, or had reentered the work force, then were dropped from Medicaid coverage, forcing them to quit working, in order to qualify for Medicaid.  The second part of the lost productivity argument is the fact that it limits Americans from doing the jobs they really want to do as they are forced to take a job with healthcare benefits, over pursuing their dreams, thus effectively killing the American dream, again.  For instance, I have a great friend back home in Virginia who owns and operates his own farm.  He is one of the hardest workers you will ever meet in your lifetime.  For years, his wife worked as a teacher, primarily for insurance benefits.  After doing some significant financial and family analysis, they determined that continuing to work for the sole purpose of healthcare coverage wasn’t worth it, so she quit her job and is now working full time on the farm.  As a result, they are gambling that their crowdfunded health insurance will sustain them should they ever have any major medical issues.  They have effectively been punished by another POS, excluding them from Medicaid, while they work 12 hour days, 6 days a week so you and I can have food on our table.  This is just one example of millions across our country that are costing productivity.  The irony here is that lost productivity, would generate more tax dollars, which could in turn be used to fund the universal healthcare program.  

So now that we have identified the problem, let’s discuss the solution.  The solution to our healthcare crisis is responsibly implemented universal healthcare, with the key words being “responsibly implemented.”  Reasonably implemented would look something like the following.  

1. Every legal citizenof the United States is automatically placed on the Medicaid system.  Since the system already exists, there will be absolutely zero cost in creating the program, only expanding the workforce to handle the extra enrollees.  But remember, nearly half of the country is already on the program or a similar one, so at worst, doubling the Medicaid workforce would be appropriate to facilitate the transition to Medicaid for all.  
2. Every working age citizen pays into the program.  This would be facilitated by some form of tax, similar to Medicare tax.  Those who aren’t working but are able bodied would pay via some form of community service a few hours a week.  Those extra man hours would increase our productivity even more within the country. Although this will be an additional POS, at least you will benefit from it now, unlike that 15% FICA tax.
3. Expanded fraud and abuse inquiry boards.  Currently, there are programs in Medicare and Medicaid that look into fraud and abuse, but they are severely understaffed and catch only the most blatant and obvious abuses.  Abuse comes in many forms, from practitioners billing for services that were not provided, to patients running into the E.R. for a band aid or the sniffles.  Find an E.R. nurse and ask them about the abuses they see on a daily basis, this should give you an indication of how many hundreds of thousands if not millions of cases annually are served and paid for with tax dollars, where the services were not necessary. Since Emergency Departments are required by the FEDERAL government to treat patients, they have to spend their time and resources treating these patients regardless if the services are warranted.  Since physicians are FEDERALLY mandated to provide care to everyone who enters the emergency room, this abuse waste not only dollars, but precious time of our doctors, nurses, and support staff who could be treating other critically ill patients.  Those caught abusing the system would be warned, then expelled from the program should the abuses continue. They can continue to receive necessary medical services, but with a bill.  Private insurance already implements this, and you the patient get a bill if they deem the services not “medically necessary.”  Since hospitals know they have a certain percentage of patients they treat but will never receive payment from, they increase the prices on those who can pay to subsidize their operations.
4. Copays for all.  Multiple studies have shown that even minor copays dissuade patients from entering the E.R. for unnecessary treatment.  Isn’t it amazing when you have to pay for something yourself with your own money how you begin to question is it absolutely necessary?  This system already works within the private sector, and I would argue too well, as high copays in the private sector dissuade those who actually work and need healthcare from receiving the needed care.  Copays should be capped at no more than 50 dollars to ensure everybody has an opportunity to receive care. Those who cannot afford even the 50 dollar copay can work off their debt, again through community service, or volunteering at the healthcare facility where they received treatment. 
5. Elimination of private health insurance companies.  You heard that right, from the far right conservative.  Saving lives shouldn’t be a Fortune 500 company.  Healthcare should be a right of all American citizens, but that’s another blog post for the future. Call me soft, but I don’t think anyone should ever make millions or even billions of dollars, at the literal expense of others.  Greed within the healthcare insurance system so some CEO can have a larger yacht, needs to be a thing of the past.  However, based on their experience, these private sector individuals should be considered to be transitioned into the Medicaid program, but solely to assist with transition to what is essentially a not for profit healthcare system.  I personally believe that not for profit healthcare systems should be the only systems going forward.
6. Exclusions for those who habitually are noncompliant with care.  There is a term in healthcare called AMA.  AMA stands for “Against Medical Advice” and is usually used to describe a patient who leaves before care is completed, or disregards medical advice altogether.  Both private insurance, and Medicare already have programs in place where the patient will usually receive the entire bill for services, should they leave against the doctors advice before treatment is completed, simply because of personal responsibility.  It isn’t the responsibility of the government or even the private health insurer to babysit you.  Those who leave AMA get a bill, just like on the Medicare and private programs already in place, and those who continue could eventually be denied care, or deprioritized from care.  We should also explore programs that really dig into the illegal drugs in this country.  It makes no sense to continue to pay for the care of someone who wants to harm their body while simultaneously paying law enforcement to address the drug crisis.  We are burning the candle at both ends.  “My body my choice” means just that.  Should you make the choice, that is fine but the government will no longer continue to pay for your poor choices, you will quite literally. I know this is a topic that will require much debate and ethical considerations, but remember the idea here is reasonably implemented universal healthcare, not simply universal healthcare.

In conclusion, reasonably implemented universal healthcare is really our only choice at this point in time. The longer we delay the transition, the more people who will suffer, be ruined financially with medical bills, and avoid treatment because they cannot afford it with their current private insurance.  With the implementation of the ACA and the Medicaid expansion program, we have long surpassed the point of no return.  Former President Obama promised to “fundamentally transform” the United States, and he was very successful when it comes to healthcare.  Nearly half of our population is already on some form of socialized healthcare within the United States today, and the only people getting left behind are those very people who are funding the programs by working and paying taxes.  Increased productivity, and decreased fraud and abuse as well as a minor tax will pay for a significant proportion, if not all, of this program, although I have no idea exactly how much.  By expanding Medicaid for all Americans, we will eliminate the second largest Penalty of Success the average working class American will ever face, which is healthcare costs.  Unfortunately, until we implement this program, those working class citizens will continue to feel the squeeze from both the ever increasing tax burden to pay for our already existing socialized healthcare, exclusion from those same programs they already fund for others, and ever increasing private health insurance costs.