Single Payer

Financing Healthcare

My pick of healthcare systems would be none. Why?

All the choices are dated. Rather than looking at a model in it’s entirety, we need to look deeper to what aspects are working and why.

What we know is that healthcare financing affects timely access and all systems no matter how they are currently financed have access issues whether it’s waitlists, the cost of care or patient’s who prioritize savings over timely care.

We also know that untimely care typically results in more expensive care. So the question should be not which system is best but rather do we shift the financing to emphasize more timely care that keeps people healthy.

The questions that everyone should be asking now are:

1/ Which companies should be at risk for keeping people healthy?

2/ Which companies should be at risk for delivering high quality care?

3/ What role should the government play to make healthcare affordable?

As an industry, we can’t answer those questions. We need to know:

1/ Who do people trust as a partner for their journey through life?

2/ How much involvement are they willing to tolerate before the solution becomes too invasive and creepy?

3/ How can we build trust?

Triple Aim

The Canadian healthcare system is undergoing a similar digital transformation as the US.

Even though the healthcare systems are different in how they are financed, the triple aim of the transformation is for the most part the same.

The triple aim:

1/ Enhance the patient experience

2/ Reduce the cost of care

3/ Increase population health

A couple of differences to note:

1/ Patient vs. Consumer experience: The US has been trying to engage patients in consumer type behavior to help lower the cost of care. The jury is out on whether it’s having the intended effect or not. However, the word consumer resonates even less in a Canadian healthcare context even though many also have private insurance and pay some healthcare costs out-of-pocket.

2/ Clinical experience and productivity: The 4th aim in Canada whether official or not, is about making things easier for clinicians in order to utilize their time effectively and to reduce the risk of errors. Given the number of reported issues with EHRs and physician burnout, most US physicians would likely sign on to that aim too.

Regardless of country, it’s hard to manage risk in large scale transformations without stifling innovation. There are differences in how the risk is being mitigated and managed. I will touch on that too.

2020 Reform

Americans have a huge opportunity to get healthcare right in 2020.

The current system is broken. Access is limited by the lack of coverage and/or the cost of healthcare.

Medicare for All would make healthcare more accessible to all American even though access has yet to be defined in terms of who and what.

Getting who and what right is the first opportunity. If the benefits are too rich, the system will become unsustainable. Reportedly, Canada is spending 60% of all tax dollars on healthcare and have reached their maximum budget. They too are trying to address the rising cost with the triple aim.

The Republican concerns are real if other measures are not taken to curb the cost of healthcare.

Expanding access helps reduce the cost/person if people use the system to better manage their health and thereby reduce the need for expensive medical intervention.

For the theory to work:

1/ Self-Care: Americans need to take a more active role in managing their health and wellbeing.

2/ Primary Care: PCPs need to engage as health coaches rather than just as gatekeepers to specialists and pharmaceuticals.

3/ Coverage: Insurers need to cover self-care apps + devices.

The opportunity in 2020 is to present a new system that focuses on health and cares for the sick when needed.

Risk Pools

Risk pools are a powerful tool but they have been incorrectly within the healthcare system.

Risk Pools are a way for insurers to share the medical responsibility and financial risk with healthcare providers for managing a defined patient population. It rarely goes well.

Providers have a few big issues:

1. Insurers have premiums and investment vehicles to absorb risk pool loses. The risk pool is a limited amount of money with no means to increase the available funds. Providers end up rationing care.

2. Managing the risk pool is about predicting future medical events. The technology and methods providers use are getting better but still pretty limited.

3. The conversation between doctors and patients is changing. Patients are more informed of experimental therapies. Telling a patient NO when there is even a remote shot of something working would be tough for someone who is invested in the relationship.

Given that many insurers are becoming provider organization offering health coaching and preventative care, risk pools would be better used between the government and insurers as a way to incentivize them to keep people healthy.

The government is also better positioned to improve access by providing the Stop Loss insurance for patients with genetic issues.

Medicare for All?

Medicare for All vs. Single Payer System

62% of Americans support the idea of “Medicare for All” even though it’s not clear what it would cover, who it would cover or how it would be administered.

So what are people finding so appealing about it? The number of people supporting a single payer system is lower. Reportedly, only 48% of Americans want a single payer system even though the two are similar in concept.

Is that people understand Medicare coverage because they have had some experience with it or in their minds is there a fundamental difference?

Single payer systems are often plagued with access issues because all the resources are being consumed by older and sicker beneficiaries. However, if something is urgent and life threatening, it gets taken care of quickly. In short, it’s reactive care. That’s probably the scary part of a single payer system for most.

However, what few realize is that many of the single payer systems around the world have a commercial layer that provides access to complimentary care providers who help keep people healthy. Interestingly, the plans are often provided by employers and include luxury benefits like massage therapy.

Single payer vs. Medicare for All: What’s the difference to you?

Single Payer System

A Single Payer System will help “Make America Great Again”.

I am convinced healthcare in American needs to become a single payer system with an option to purchase private insurance. Why?

Many American are still slipping through the cracks of the current system because it’s so fragmented. With health insurers pulling out of the exchanges and the uncertainty of CHIP, even more Americans are likely going to slip through the cracks in 2018.

While reading Option B this weekend, I learned that 46% of Americans cannot afford to pay $400 in the event of an emergency. It’s no wonder hospitals are seeing an increase in bad debt. The average deductible in 2016 was just shy of $1500. With more Americans trying to lower their premiums, it’s reasonable to expect deductibles will continue to increase. Higher deductibles and out-of-pocket maximums means many Americans are underinsured and exposed to excessive financial risk.

Illness is a factor in more than 40% of bankruptcies and there is evidence that people with cancer are more than 2.5 times as likely to file for bankruptcy. Even relatively small unexpected expenses can have disastrous consequences: 46% of Americans are unable to pay for an emergency bill of $400. ~Option B by Sheryl Sandberg and Adam Grant

People need a certain level of support to shift into growth mindset which is essential to return America to greatness. Healthcare is an essential part of that support. As Sheryl acknowledged in Option B, paid family leave, quality healthcare and mental health coverage make the difference between people falling off and hanging on. In other words, they are essential to life.

Many leaders are acknowledging now that capitalism is not working for the vast majority of Americans. The fundamental goals of business and the welfare of Americans are misaligned.

I fully agree that the capitalist system as we know it with regards to compensation is severely out of balance when you compare the growth of executive level compensation with that of labor….The U.S. Middle Class is shrinking compared to the base of 1962 and is now about 47% of the population from about 62%… These are the kinds of trends that lead to social and political upheaval. ~ Fortune, CEO Daily

What’s clear is that we’ve tried to make universal healthcare coverage work and we’ve allowed things to get so far off track that we need to do something dramatically different. It’s time for Option B in healthcare.

We should consider a single payer system as the base of the American system. Access to healthcare should not depend on where people live or who they work for because it’s an essential service for the health and welfare of all Americans.

A single payer system is going to be expensive but to “make America great again” we need to reinvest in all people rather than just lining the pockets of the 1%. Warren Buffet one of the wealthiest people in American is onboard.

 

Subscribe to RUSH 360 for the latest developments in healthcare as well as our thoughts.

About the Author: Shannon Smith is a healthcare strategist with over fifteen years of experience helping companies achieve greater success. She is also the founder and CEO of Hello Workout.