ANALYSIS: The 2 options for US health care likely to emerge in the next decade

In my previous essays I have outlined the huge problems with cost, quality and access facing American health care. Indeed, the problems are so difficult and politicized that it is hard to believe there can be solutions. But I have come to believe there are ways to address all three problems.

First, most experts agree on the main features of any good national health insurance program:

1. In order to keep the costs as low as possible for everyone, the risk of having to use the insurance should be spread as wide as possible. The basic concept is that people who don’t currently need insurance help pay for those who do, recognizing that eventually we will probably all need it.

2. Requiring everyone to participate in a health insurance pool eliminates the unfairness factor — i.e., the probability that some people will not buy insurance because they know they will be taken care of when they need help. But, when that happens, the rest of us pay more in taxes and increased premiums.

3. Any good national health insurance program should be consistent and available, no matter where you live or work — i.e., it should not change with circumstances beyond your control such as sudden job loss, need to relocate or pre-existing conditions. Having such a program also helps because experts will negotiate cost and coverage instead of individuals trying to pick from various complicated options.

We already have such an insurance program available in this country, but you have to be over 65 to get it. Medicare meets these basic requirements for good health insurance, with one exception. Congress greatly limited its ability to negotiate on our behalf by not allowing Medicare to negotiate drug prices.

Having used Medicare as my primary insurance for more than 15 years, I can’t begin to tell you how much I appreciate the security and simplicity it provides.

In fact, whenever I speak to groups about health care reform, I always ask people in the audience who have Medicare to raise their hands. I then ask anyone who wants to give up Medicare and go back into the private health insurance market to lower their hand. I have yet to see a hand go down.

Read articles in this series:

Part 1: ANALYSIS: 3 health care problems could shape the next decade
Part 2: ANALYSIS: Health care spending reforms are critical to change the system
Part 3: ANALYSIS: Health care quality will improve for all, if we have a federal watchdog
Part 4: ANALYSIS: Health care should be a right, but the US doesn’t have a system

That’s because the current private health insurance market is chaotic and unpredictable. And, if Congress weakens the federal regulation of health insurance and turns more power over to the states, we will have even more chaos — with insurance companies in less regulated states trying to lure buyers with low cost plans that will offer very little actual coverage — in other words, junk insurance.

So next time you hear politicians criticize single-payer or government control, ask them if that means they want to end Medicare and take it away from senior citizens. Medicare is classic single-payer — meaning the federal government does the financing by collecting the money via taxes and paying the bills after negotiating much lower prices with doctors and hospitals than individuals could do on their own.

And Medicare is not socialized medicine, as in Britain, where the government does the financing, as the single payer, and also owns and operates the doctors and hospitals. Medicare allows us to pick our own doctors and hospitals, regardless of where we live and no matter our health status.

So why not Medicare for all?

One reason is that the private health insurance industry in this country has Congress in its pocket and will fight it to the death, as oy did when President Obama tried to introduce a Medicare-like public option in his bill.

Dominick Reuter/AFP/Getty ImagesMedical Assistant Gloria Castro administers an injection to patient Angel Rosa at the Esperanza Health Center in Philadelphia, on March 13, 2017.

However, given the huge overhead costs of private health insurance, including marketing and profits, eventually the dramatically lower administrative costs of a single payer system will become very appealing.

Medicare does have its problems, especially in controlling medical costs. The current fee-for-service model in most of Medicare invites large amounts of unnecessary care — and fraud.

Obamacare health plans still available despite uncertainty over law’s future

Another pathway to universal health insurance coverage could be a hybrid model used by many other developed countries: the preservation of private insurance companies but under federal government control in terms of cost, quality and access.

Politically, this option might be more palatable, but I have very little faith that government and the private sector can pull this off given our present political climate.

So given the current political gridlock in this country, my prediction is that we will limp along in continuing political dysfunction, trying one Band-Aid solution after another, until the costs of health care reach such a critical point that there will be an emergency meeting in Washington, like what happened during the banking crisis.

When we reach such a critical point, the U.S. will probably adopt either a single payer or hybrid heath insurance system in order to align spending in one place.

Unless some kind of political miracle occurs to make this happen sooner, I predict it will take about 10 years.

This is the final article in a five-part series. Read previous articles below:

Part 1: ANALYSIS: 3 health care problems could shape the next decade
Part 2: ANALYSIS: Health care spending reforms are critical to change the system
Part 3: ANALYSIS: Health care quality will improve for all, if we have a federal watchdog
Part 4: ANALYSIS: Health care should be a right, but the US doesn’t have a system

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