Time for a better healthcare system

Imagine if every single person in the United States had access to quality health care services without the risk of financial hardship. Now imagine this hypothetical healthcare system costing a third less than the current system and resulted in better outcomes. Imagine the difference it would make to both businesses and their employees. Imagine the difference it would make for people if they had access to good healthcare at a very reasonable cost no matter what else was happening in their life.

Universal healthcare is a reality for hundreds of millions of people around the world. The United States is the only industrialized country without universal healthcare. The United States pays the highest percentage of our GNP on healthcare. In the United States, life expectancy at birth is ranked as 43rd best. Our infant mortality rate is rated 170th.

We spend about $9,892 per person per year on healthcare coverage. The countries with the best outcomes spend two-thirds to a half of what the United States spends. There is no credible ranking of healthcare systems which rank the United States system very high. Compared to other nations, the United States healthcare system is ranked,  37th84th, 11th of 11 countries and you get the idea.

The bottom-line is the current U.S. healthcare system cost the most and delivers mediocre results. Medical expenses are the leading cause of bankruptcy. Over twenty-eight million of us do not have health care coverage.  The list of reasons we need to fix the U.S. healthcare system goes on and on and on and on. It is time for a better healthcare system.

The people of the United States need a universal healthcare system. Our political system is not functioning at the level needed to get us there. Likely major corporations will form consortiums which will “create” a version of Universal healthcare which we (the population of the USA) may then join.

The World Health Organization defines universal health care as “…all people having access to the health services they need (prevention, promotion, treatment, rehabilitation and palliative care) without the risk of financial hardship when paying for them.”

The major components of a universal healthcare system are:

  • Governance – The policies, strategy, and plans
  • Financing – Who pays for what
  • Workforce – The people who provide the healthcare service directly or indirectly
  • Information systems – The key component and primary focus of this post
  • Access to affordable essential medicines, vaccines, diagnostics and health technologies of assured quality

Governance

Governance of healthcare in the United States is a combination of federal and state regulation which came to be from a wide variety of forces. It is a mish-mash mess. What we need is a standardized set of rules focused on quality healthcare outcomes. Our rules should not be primarily about politics and or profit margins. Assuring good, cost-effective healthcare outcomes for all Americans is the goal.

The strange thing about needed governance is there are already established best practices. The information is available. We already have processes in place to monitor and update the best practices. Sure, there are debates about the processes but the discussion will be about tweaks not starting from scratch.

Healthcare does not exist for the primary financial benefit of the stockholders of healthcare providers. Healthcare does not exist to enforce religious beliefs of the few over the many. Healthcare is about providing quality healthcare to everyone.

Financing Healthcare

Healthcare is currently paid for by a variety of methods. Taxes, employer benefits, private insurance, direct payments, health savings accounts, grants, and the like.  I am sure I have missed several of them. The goal is coverage “… without the risk of financial hardship when paying for them”. A new universal healthcare system will likely be paid for by some combination of the same sources.

The real debate will more likely be about whether the system will be single payer healthcare or multi-payer. Single payer is a single public system, think Medicaid or Medicare. Or multi-payer which is a combination of both public and private payers.  Since our political environment is as dysfunctional as it is, likely a multi-payer system will be needed.  Think a combination of Medicaid, Medicare, employee benefit plans, and private individuals all paying for coverage from a universal healthcare plan.

Workforce

Per the Bureau of Labor Statistics, there are about 19 million healthcare workers in the US. That is a good base of experienced, knowledgeable healthcare workers. We also have about one-half million health and medical finance related employees.

As we transition into a universal healthcare system the number employees in various healthcare related categories will likely shift. Predicting how much it will shift and who will shift is a fool’s errand. There are just too many variables. The key to remember is that we have an educated population and we have the potential to educate even more of our population. We have the infrastructure and processes in place to educate and help people transition to a new work environment.

Information systems

One of the unique things about the USA is internet usage is pervasive. The universal healthcare solution for the United States can assume that people are connected because we have the infrastructure in place and in fact, the vast majority of Americans are connected.

We also have secure cloud services and the ability to use “big data” analytics. There are existing apps for many healthcare-related activities and the expertise exists to create more apps as needed.

I am not going to pretend I know the secret sauce for an instant universal healthcare system. However, from my perspective, the key is the ability for a patient’s complete electronic medical records to be available to whomever the patient designates.

That will allow the user to easily seek other opinions. It will also break the virtual monopoly healthcare providers enjoy because once they get someone in their system, it is convoluted/hard for them to move to another provider.  It would facilitate the ability to shop for a qualified but less expensive provider.  It will also allow the analytics to suggest a more appropriate provider.  Maybe the analytics will be able to warn the patient that the prescribed service is not deemed appropriate to the malady. Maybe the provider would be less likely to suggest an inappropriate service since they know the system will raise a red flag.

The right information system designed with the best outcome for the patient is probably the key for the U.S. to move toward a universal healthcare system.

Access to affordable essential medicines, vaccines, diagnostics and health technologies of assured quality

In recent years retail, transportation, accommodation, and other industries have shown the power of systems to fundamentally change those industries. There is little doubt that systems will fundamentally change access to healthcare. Disruptive technology will likely revolutionize healthcare delivery.

Conclusion

Our political environment makes it unlikely universal healthcare will be achieved by the political process.  More likely businesses and other groups will form alliances which will result in the creation of a universal healthcare option.

The reality is, we need a system designed to work best for the people of the United States. It needs to cost less than we spend now and the outcomes need to be better.  We want that system to result in all people having access to health services including prevention, promotion, treatment, rehabilitation and palliative care without the risk of financial hardship when paying for them.

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