Healthcare in America — The Next Conversation Part 6 – Wait a Minute
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- Healthcare for all
Part 6 – Wait a Minute
We’ve spent a lot of time looking at what other countries have done, what we already have here in the United States, how our existing programs work and, in Part 5, how we currently pay for them. We’ve looked at Medicaid, Medicare and Veterans healthcare, and we’ve looked at the private insurance system that covers the enormous group of Americans who fall somewhere in the middle.
And after all that, I think I may have been looking at this from the wrong mountain.
I started this series thinking about what we would have to build to create healthcare for everyone. I was thinking about hospitals, doctors, nurses, insurance, government programs, funding and all the other pieces that would have to be assembled into some enormous new system.
Then I stopped and thought about it.
Wait a minute.
Maybe we already have most of it.
We have the hospitals, the doctors and the nurses. We have specialists, pharmacies, laboratories, physical therapists, rehabilitation facilities, mental health professionals and thousands of private clinics. We have an enormous medical infrastructure already operating in every part of the country. We have Medicare, Medicaid and Veterans healthcare already paying for medical care for millions of Americans, and we have private insurance covering millions more.
So perhaps the question isn’t whether America has the ability to provide healthcare.
Perhaps the question is who gets to use the system, and how do we pay for it?
That changes the discussion considerably.
The easiest and potentially most dangerous approach would be to design one enormous new system that covers everyone and replaces everything we currently have. It sounds good on paper, and I might have argued for exactly that when I started this project back in Part 1.
The more I learn, the less attractive that idea becomes.
We already have millions of people depending on Medicare, Medicaid and Veterans healthcare. Those systems aren’t perfect, but they are functioning systems, and people depend on them. I don’t think we should put those people at risk simply because we have decided that the system needs to change.
So rather than tearing everything down and starting over, what if we built the missing piece?
Medi for Everyone Else
I’m going to call it Medi for Everyone Else for now, because I haven’t thought of a better name and because the name explains the basic idea.
Instead of replacing Medicare, Medicaid and Veterans healthcare, we create another federal medical insurance program designed primarily for the people who currently depend on private insurance or have no insurance at all.
That would include the enormous number of working-age Americans who don’t qualify for Medicaid and aren’t old enough for Medicare. Most of them already have private insurance, generally through an employer, while others purchase insurance themselves or remain uninsured.
And this is where something else becomes possible.
We don’t necessarily have to combine everything immediately.
Medicare could remain Medicare. Medicaid could remain Medicaid. Veterans healthcare could remain Veterans healthcare. Medi for Everyone Else could be built as a separate program and allowed to work out its problems without disrupting the programs that are already providing care.
Over time, the systems could become more compatible. The transition from Medicaid into the new system, or from the new system into Medicare, could eventually become much more seamless. We could even look at what happens when people move from one program to another so that changing eligibility doesn’t also mean changing doctors, pharmacies and an entire set of rules.
This would cost more money in the beginning because we would be adding something rather than immediately eliminating something else.
But there is an advantage to that.
We could learn as we go.
If something doesn’t work, we fix that part without bringing the entire healthcare system down with it.
That matters because healthcare isn’t just doctors and hospitals. It is an enormous ecosystem of people, businesses and institutions that depend upon one another. There are rural hospitals that are already struggling, private clinics, specialists, pharmacies, laboratories, medical equipment companies, administrators and thousands of other businesses supporting the system.
There is also mental healthcare, something I don’t think we have come close to solving. It seems that our national strategy has too often been to ignore mental illness and hope it goes away.
Spoiler alert: it doesn’t.
It is right there in homeless encampments, on the streets, in emergency rooms, in jails and prisons, and in families that don’t know where to turn. If we are serious about healthcare for everyone, mental healthcare can’t remain the forgotten stepchild of the system.
And there is another potential advantage to having several publicly supported programs working toward the same basic goal.
Bargaining power.
Medicare already has enormous purchasing power when it comes to prescription drugs. Now imagine Medicare, Medicaid, Veterans healthcare and Medi for Everyone Else negotiating together.
Instead of four programs buying independently, they could potentially act together when negotiating prices for drugs, equipment and other services.
I’m not saying that would automatically work. I’m saying it is something worth investigating.
The same principle applies to administration. There may be places where combining functions makes sense and places where keeping them separate makes more sense.
And that brings us back to something we discussed earlier: perhaps the long-term goal should eventually be one system, but the path to get there should be deliberately slow.
In the long run, one comprehensive system might reduce administrative costs, eliminate some duplication and provide greater equality in coverage. But getting there in one giant leap would create an enormous opportunity for failure.
I’d rather see us take one step, make sure it works, take another step and keep going. Build it as a living program. Let it grow. Let it respond to the needs of the people it serves.
After all, if it is going to be healthcare for the people, then it should be something owned by the people.
It isn’t a gift from Washington.
It was never Washington’s to give.
| Healthcare For All, The Evolving Series |
