The Potential Benefits and the Identified Challenges of Universal Healthcare for the United States

By Stephen F Hightower MD FACP

“Universal Coverage, not medical technology, is the foundation of any caring health care system” - Richard Lamm

The exciting concept of providing all Americans with health care is a very plausible scenario that could be initiated by either political party in office, providing they have the insight to understand both the advantages and significant concerns such an immense program would involve.

Initially, the type of Universal Plan would have to Identified. This includes three options:

First, is the single payer option? This is where the government provides paid healthcare for all through income and other tax revenues.  All citizens (even those who do not have a job or source of income) have the same access to the government owned/hired services.  This is the typical United Kingdom scenario and would likely be close to how the United States would work.  The key ꟷ will the payments provided by the government be acceptable to the providers or will the patients have to supplement for any or all services?

Second, is the government-run health insurance fund financed by payroll tax on employers and/or employees.  Private doctors and private hospitals provide services.  This is typical of Germany.

Third, is the publicly funded and privately delivered scenario where every citizen pays into a national plan provided by a single insurance company.  This is the Canada Plan.

The most likely potential for the United States would be a Federal Government payment of health care along the scenario of the care provided through its currently in place Medicare Program, which has obtained some of the workers paycheck assets during their lifetime of work.  This system currently allows individuals to access a large swath of single or group-based physicians and hospitals who have agreed to accept Medicare payments for services rendered. Also, many, though not all, independent physicians or hospitals will have agreed to this plan.  .

A universal health care system, however, would provide medical services to all people regardless of prior contributions into the system or their current ability to pay. In general, funds raised through taxes would supplement the monetary assets acquired during millions of peoples work years, as well as those from the assets of the currently working to cover the cost of care for all.

The actual cost of a universal health care system has been widely evaluated.  The Congressional Budget Office has estimated that by 2030 federal health care subsidies would increase by $1.5 to 3.0 trillion if the Universal Health Care program has been initiated.  The Congressional Budget Office (CBO), concluded that the single payer options would greatly increase federal subsidies for health care, and the government would need to implement new financing mechanisms such as raising taxes, introducing new ones, reducing spending, or issuing federal debt. 

The specific monetary analysis of Senator Sanders Medicare for All plan in 2017 was identified at a cost of 2.5 trillion dollars per year with an average of 1 trillion dollars per year financing shortfall.  To fund the program, payroll and income taxes would have to increase from a combined 8.4% to 20 percent while still retaining all capital gains, and estate taxes.  70% of all working, privately insured households, would pay more taxes.

Besides cost increases, the other poorly tolerated challenge for United States citizens is  waiting. The CBO also noted that the single –payer system would likely lead to increased demand for care in the US because both those with new coverage and those already covered would use more services.  The ability to meet this demand would likely depend on payment rates, access efficiency, severity of diagnosis, and likely, the actual demand for medical care would probably exceed the supply of care available.  

This would dangerously increase wait times for surgeries, cause significant individual challenges for access, and reduce timely preventative care procedures or physician discussions, resulting in unmet demand for needed care.  A prophetic example from Canada occurred in 2017 when Canadians were on a waiting list of 1,040,791 for a single procedure.  In England, a recent elective hospital-based care was 46 days out.  One would strongly anticipate that increased wait times would certainly occur in the United States in the short term, and there would likely be a steep rise in primary and emergency care visits.

Our American Culture is not typically use to excessive waiting or receiving less than high quality in almost everything.  Our healthcare culture is no different.  We are used to having access, mostly getting what we want, or at least an accurate explanation of why not.  A new culture of having more limited access, significant time delays, less supply, and overwhelming demand, would not work well in the American System.

If we decided to initiate such a system, then we need to have essentially universal support and buy in, that United States Health Care is the priority for Health Care in our Country, and we will need to have all of the Doctors, both Medical and Osteopathic, Residents, Nurse Practitioners, Surgeons, RN’s and LPN’s, advanced practice Nurses, Hospitals, Health Aides, Pharmacists, Clinics, and Private Offices, ready to sign on for the job, that will provide that humane and helping care for every citizen within our country.  

Respectfully submitted,

Stephen F Hightower MD FACP

Rio Rancho

fixingushealthcare.com

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