Universal Health Care – Pay While You are Healthy

The fear uncertainty and doubt over the issue of providing healthcare to everyone in the US is debilitating. And consider the range of special interests who reject the notion and fear any solution that involves the government. The recent press conference by President Obama (full text here and on the whitehouse blog in video format) while focused on the economy mentioned healthcare (17 times by my count) as the underlying problem:

the biggest driver of long-term deficits are the huge healthcare costs that we’ve got out here that we’re going to have to tackle and we

And

But it is — it is going to be an impossible task for us to balance our budget if we’re not taking on rising healthcare costs

And

…the reason it’s hard is because we’ve accumulated a structural deficit that’s going to take a long time, and we’re not going to be able to do it next year or the year after or three years from now. What we have to do is bend the curve on these deficit projections. And the best way for us to do that is to reduce healthcare costs. That’s not just my opinion. That’s the opinion of almost every single person who has looked at our long-term fiscal situation.

Naturally the reactions were wide and varied but I think he’s right about the healthcare cost issue and the need to focus on this. The proposal he floated at the recent healthcare forum was a Medicare like insurance plan to anyone at any age concurrent with commercial insurers offering private insurance. The detail was covered in the NY Times Piece: Health Plan for All and the Concerns It Raises that detailed the inevitable rejection by the insurance industry:

But the insurance industry and others wary of too much government intervention vehemently oppose the idea. They say the heavy hand of the government will eventually push out the private insurers, leaving the government option as the only option. That is why the industry seems unwilling to give ground on the issue, even while making other concessions to national health reform — like the industry’s announcement on Tuesday that it might be willing to stop charging sick people higher rates than healthy customers.

Interesting that finally there is some focus on the terrible circumstance that the uninsured and sick people find themselves in. The issue of the costs for uninsured patients was highlighted in a compelling episode of “30 Days” by Morgan Spurlock (of “Supersize Me” fame) titled Minimum Wage. The series was simple – take on a specific circumstance and live it for 30 days. Morgan did with his girlfriend living on a minimum wage (summary and the episode here). As he said

We don’t see the people that surround us. We don’t see the people who are struggling to get by that are right next to us. And I have seen how hard the struggle is. I have been here. And I only did it for a month, and there’s people who do this their whole lives.

and Alex his girlfriend who unfortunately developed a Urinary Tract Infection that required treatment said:

Even if you are among the “working poor”, and working two jobs at even above minimum wage, you’re still just barely gonna make it, and God forbid anything happen to you. It’s really, really, really hard

They just about coped but it was the healthcare costs that drowned them. Alex’s urinary tract infection required an early morning trip to the ER to be seen and receive a prescription for antibiotics that they had to fill at CVS across town for $20 – this on top of 1-2 days of not working. Morgan hurt his wrist but had to keep working as he had no sick time and that made his wrist worse. He tried to use a free clinic but it only took 20 people and he was number 35. A days wage lost and still no treatment. He eventually had to take a trip to the ER where he got a $40 ACE bandage. With no insurance and hence no cap or control on the bill their total bill was around ~$1,000 or put another way three months salary.

It’s no wonder the insurance industry is vehemently opposed to any intervention that might provide alternative choices to the outrageous bills leveled on individuals who have no insurance. This was very much the principle behind Jay Parkinson‘s service that he started offering some time back in NY and has since moved to Williamsburg with Hello Health. Providing affordable access to healthcare to everyone and identifying the best suppliers of drugs, procedures and health care services for his patients.

For the healthcare providers there is a tremendous fear that the price pressure of such a system will bring them to their knees. This process has already driven down the time available to see patients to ~7 minutes……why because to maintain income if the price paid per unit falls you need to do more units (in this case units = patients).

The trouble with all these methods is we value the healthcare received incorrectly based on activity without focus on prevention and keeping people healthy. The system is complex, stocked full of a wide range of special interests and groups that have and want to continue to make great money from the system. The system is also full of many well intentioned clinicians and care givers who struggle to maintain their income and deliver the service that their patients need and want – it’s a mess.

So here’s a radical thought that I have no doubt will raise a few eyebrows and there will undoubtedly be a host of people suggesting reasons why it might not work but here goes:

Hark back to days gone by in Chinese villages where the villagers paid the medicine man when they were healthy. When they fell ill they stopped paying until they were better and able to work again.

• Incentive – keep patients healthy – check
• Compensation – reasonable and paid based on population under care – check
• Cost – see above based on reasonable level set for population cared for – check
• Catastrophic coverage – check
• Shared insurance risk – check

I know too simplistic for our complex world today but you have to admit there is a certain elegance and beauty to the proposal. Like it, hate it have ideas on how to make it better – leave your comments