Welcome to the second part of my personal perspective on health care as the debate has been taking shape. Last time, we discussed the great philosophical debate of health care as a right or privilege, and the fragmented conglomeration of laws that make up our health care. While I have my own answers to many of the questions posed by this discourse, and I’m sure everyone else does too, I wanted to put forward some suggestions of benefits to a universal health care system of some kind that maybe we don’t ordinarily consider in this discussion, or at least some uncommon analogies for common concerns.
1. Research and Quality Improvement
If everyone is covered by the same entity, the amount of incredible population level research that can be done would be phenomenal. We would no longer have to “extrapolate” to the population, wondering if results are generalizable. We could, in fact, study the entire population. They do this already in the Netherlands and Sweden.
Before you start thinking “Big Brother,” ask yourself if this is any better than what many hospitals do now regarding selling patients’ health data, albeit “deidentified” data.
2. Access to Care
Currently, if a private hospital or physician doesn’t like the health insurance “club card” you show them and belong to, or if you don’t have a “pass” at all, then you get shipped elsewhere. Or worse: you are denied and sent to fend for yourself. The alternative? A system designed like a shopping mall, where once you’re in you can go wherever you want. No one stops you at the door, checking your credentials, sending you to another store because this one is too high-end for you. Like the Veterans Administration hospitals, any veteran can walk in to any of these hospitals and get care, for the most part.
3. Cost Containment
Admittedly, EVERYONE talks about this. But this goes beyond administrators and unified paperwork. If you think from a business perspective, it doesn’t make sense to contract with 23 different makers of boxes. If you reduce the box supplier contracts your company has, you will save money as you force your suppliers to cut their costs and compete for your contract. Also, you won’t have to deal with the ordering and shipping process of every supplier, and therefore staff could be allocated to other endeavors (making the patient office visit experience pleasant, for example, by checking in on people, sitting and talking to them, etc.) But think now further down the supply chain. Currently, every hospital wants to provide every service line whether they need it or not. Why should a small city offer multiple organ transplant surgeons or programs for example? Hospital systems hire multiple providers in a specialty just to cover the call, even though they may not have the volume for all these providers, and they do this out of competition with nearby systems. How much could we save if we didn’t have to repeat, for example, an ultrasound, CT scan, or blood test because we “didn’t trust that lab?” Quality and quality control could be standardized as well.
4. Access to Medical Records
This is a no-brainer. If there is a single system, then there can be a unified electronic health record, and any provider can have access to any other provider’s documentation. How much time spent tracking down documents would this save physicians? How much cost would this save if x-rays and CT scans, or worse, invasive procedures such as angiography, were available ubiquitously and didn’t have to be repeated?
5. Improved Daily Delivery of Care
While medical malpractice may never go away, a system backed by the government for example could result in more difficulty for frivolous lawsuits. Better standardization of care could decrease the amount of “defensive medicine” in practice and return us to just practicing medicine. (How novel!). Additionally, physicians practicing in accordance with nationalized standards can be rewarded more easily. Patient behavior likewise can be rewarded with incentives, credits, etc. For example, patients who quit smoking after a heart attack could be given a discount in premiums or out-of-pocket expenses.
6. Reduced Downstream Nonmedical Costs
A recent health plan proposed by Michigan gubernatorial candidate Abdul El Sayed argued that a universal health care plan would reduce homeowner and car insurance premiums as the potential medical costs these plans might cover would now be covered by the universal system.
7. Insurance Portability
Health insurance would no longer be tied to one’s employment. This would mean that insurance would follow a person from job to job. Additionally, it would liberate people from needing to switch insurers simply because one covers something that the other does not. It would liberate people from being hit with bills because that consultant they saw happened to be out-of-network and the "oops, sorry, you didn’t know but it’s your responsibility to pay" situation. It can put people at ease when they travel.
None of these items necessarily requires a universal health care system to achieve, but all are more easily attained under a universal system. Avoid the status quo bias, and most importantly, don’t knock it till you’ve tried it!
Dr. Issam Koleilat is a vascular surgeon at Montefiore Medical Center/Albert Einstein College of Medicine in the Bronx, NY. He is also the proud father of a wonderfully curious five-year-old daughter and bright-eyed five-month-old son, and the husband of a breast cancer genetic epidemiologist. He enjoys traveling with his family, and as the kids get older he hopes they will hike, ride horses, and rock-climb more.
Dr. Koleilat is a 2018–2019 Doximity Author.
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