The Public Option or (ahem) Single-Payer: Solutions to a Growing Healthcare Monster?

Politically, I’ve been accused of being just a little to the right of Attila the Hun. That’s really not fair…to Attila.

I only open with that slight bit of hyperbole to underline the fact that this is not a corner of the world where you might expect to find a discussion about the value of the public option or a single-payer healthcare system as a solution to what is becoming a completely out-of-control sector of the economy. But in this political season, where vicious verbal spitballs are tossed at opponents with nary a care for veracity, perhaps it’s time for each of us to take a step back and look at point of view we haven’t really considered before. Just to set an example to the flamethrowers in Cleveland and Philadelphia, of course.

Not Just Too Expensive, But Too Complicated

The loud political rants about healthcare focus on the exorbitant costs of hospitals, nursing homes, drugs, doctor’s salaries – if you are reading this you are already familiar with the litany of complaints. Drugs running more than $100,000 a year are hitting the pharmacy shelves with increasing frequency.  Health insurance premiums are skyrocketing  to pay for it, with patients bearing much higher deductibles just so they can feel a bit of the consequence of their choices – both in taking responsibility for maintaining their health and for the treatments they select. 

Within the last year, I’ve seen a proposal that patients be allowed to take out what amounts to a mortgage to pay for some of the higher-priced treatments. That means as you begin to pay off your college debt sometime around the age of 50, you can start to look forward to assuming another big bill to stay on this side of the grass. Ouch!

Patients aren’t the only ones feeling the pinch. Health insurance companies are sinking under the weight of regulations and requirements so onerous that they can no longer operate under a legitimate business model – meaning one that might result in a profit. (“Heaven forfend any private entity make a profit,” – thus spoke Attila’s little sister sarcastically.) Instead, we saddle the insurance companies with so many competing requirements (medical loss ratios and basic plan standards, for example) that not even Houdini could get out alive.

Since I have spent much of my career consulting in the pharmaceutical industry, I might let this particular sleeping dog lie. Suffice to say, patients and other payers in the United States pay the brunt of the cost of drugs mostly because we can. We just can’t for much longer. In most of the rest of the world, drug prices are capped or some places are just so poor the drug companies give it to them. Expect that to change as the economic balance in the world shifts. It’s an industry that is shifting its business model because the old one is not sustainable.

Let’s Talk Complicated

If you couldn’t sink our healthcare system with ridiculous costs, including more indigent patients, you might be able to poke the last hole in the boat by saddling all the stakeholders with an increasing amount of paperwork and regulation. At some point, the players just give up.

Doctors, hospitals, health plans, patients, biopharmaceutical and device manufacturers all now live under so many regulations and requirements to do business, that doing business in a rational way is becoming increasingly impossible.

That is not hyperbole. That is reality. Think Meaningful Use.

At tax time, patients have to prove they have health insurance or pay a penalty.

Physicians are required to prove they meet quality measures which change all the time, are incomplete or just plain un-meetable. In order for physicians and hospitals to qualify to be paid by Medicare and Medicaid, they have to meet so many constantly changing rules, regulations and requirements with shifting deadlines that some have thrown up their hands and want to opt out of taking public money completely. But not so fast. If you are a physician or a hospital, most of your patients are over 65 and have Medicare or are indigent, disabled or in some way unable to work and are on Medicaid. It isn’t that easy to just opt out.

I’ve already discussed the difficult rock and hard place in which health insurance companies find themselves.

Would Single Payer Just Be Easier?

What does all this have to do with the public option or a single payer system? A lot. At some point, the focus needs to return to a simple transaction between a patient and a healthcare provider where the only issue on the table is the patient’s health. Perhaps the only way to make that happen is to remove business from the business of healthcare and provide a universal option. Because simply, if government needs to regulate business to the point where it is almost impossible to conduct it in a rational way, perhaps it’s time to get out of the business altogether and just concentrate on providing healthcare where payment is off the table completely for most patients.

Attila’s little sister could argue against that previous paragraph all day long because every word comes with a caveat. None of the aforementioned is as simple as I’ve stated it, but in the end, it seemed important enough to look at how other people see the problem. The problem is getting healthcare to people who need it, and a lot of effort and money is spent doing anything but getting doctors and patients together in the interest of the patient’s well-being.

I really do invite all kinds of comments and disputes to my facts and my reasoning. It’s a political season, and it seems like a good time to look at a political solution to a growing monstrosity of a problem high on the agenda of both parties.

 

 

 

 

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