If you’re reading this, you probably find the American healthcare system to be incredibly confusing–and it is! Between confusing words like Medicare and Medicaid, complicated economic explanations, and politicians yelling at each other over the subject, it’s no wonder that most young Americans choose to stray away from the topic of healthcare and its reform.
So, why should you care? Here’s just a few reasons:
The American healthcare system is a $3 trillion slice of our economy.
The average American spends $10,345 per year on healthcare.
The vast majority of Americans–upwards of 75%–view a “Medicare-for-all” system as a favorable change for our nation.
This article will make the case for reforming healthcare to strengthen both public AND private healthcare, and explain why both are needed for American healthcare to succeed.
Breaking it down–Private vs. Public
Let’s start with the basics: what is the difference between public and private healthcare?
Private healthcare is exactly what it sounds like: healthcare that americans pay for on their own or are provided by their employer through independently run insurance firms.
Public healthcare is paid for by the government, through our taxes, and is available to those who apply and are eligible. There are two general types of public healthcare: Medicare and Medicaid. To put it most simply, Medicare is for the old and Medicaid is for the poor. It’s estimated that the booming enrollment of public healthcare will rise by 30% by 2022.
Theoretically, someone with Medicare or Medicaid should be able to go to any clinic and have the government pay for their treatment. So, if most Americans are in support of this, and that it would provide free healthcare, what’s the problem? The unfortunate reality is that the public healthcare coverage doesn’t quite work in practice like it does in theory. The government frequently reimburses hospitals below the actual cost of the healthcare, so many people are turned away from specific treatments and clinics.
Because of this, many Americans are turning to private insurance to fill the gaps. In fact, 75% of medicaid patients have their healthcare managed by a private firm.
The good news is that Medicare provides options. Medicare can be divided into four concrete elements that have started to bridge the gap between public and private.
Do we have existing entirely public healthcare already in America? Yes–it’s called the VA
How effective is it? The Department of Veterans Affairs unfortunately has been cited for ineffective management, resulting in longer waiting times to receive healthcare. The VA employees have been blamed for having issues with incorrectly processing applications and deleting applications before they go through.
These incorrect handlings have resulted in untimely or inaccurate processing of healthcare records, which has had a deadly effect on veterans in need. What’s the effect? Well, veterans have died while waiting for their healthcare applications to be processed, and just as many other vets have lost their 5-year eligibility for healthcare.
For those that are not aware, the Veterans Health Administration is America’s largest integrated health care system, providing care at 1,243 health care facilities, including 172 medical centers and 1,062 outpatient sites of care of varying complexity (VHA outpatient clinics), serving 9 million enrolled Veterans each year.
Though there have been some issues, there are simple solutions which may not be easy or simple to implement but the issues have been identified and now must be fixed. These solutions can be done by investing, consolidating, and integration. It can be done with the right amount of funding, major improvements in outpatient care and the closing of under-performing facilities. “Today, the VA’s inpatient and outpatient facilities are already connected through an existing electronic health record system (which stands as one of the best in the nation). Combining it with new, state-of-the-art video and digital technologies would ensure all veterans have immediate access to care and specialized expertise, regardless of their conditions. Such an approach would eliminate the redundancy of low-volume, poorly staffed locations, replacing them with highly specialized, tech-enabled sites that deliver both higher quality and lower costs.” There is hope! Which is important for the future!
Healthcare in other developed nations (Canada UK)
Politicians often compare the United States’ healthcare systems to other developed nations, like Canada and the United Kingdom. But what does healthcare really look like for our neighbors up north and across the pond?
Canada has a publicly provided healthcare system, in which the provinces and territories administer their own universal health insurance programs. These programs are funded by provincial and territorial public spending (taxes), which account for over 90% of public healthcare spending in Canada, and the federal government contributes over $28.8 billion towards this financing.
Such a largely funded public program should have abundant resources and high consumer satisfaction, right?
Wrong. Canada’s public healthcare system has problematic aspects of its own. In 2017, Canadians were on waiting lists for an estimated 1,040,791 procedures with lengthy waiting times lasting as long as 20-52 weeks for “elective” surgery. Because of this, an estimated 63,459 Canadians received non-emergency medical treatment outside of Canada.
Similarly, in the United Kingdom through the British National Health Service (NHS), procedure cancellations are common. In 2017, the NHS canceled over 84,000 operations for nonclinical reasons on the day before the patient was scheduled to receive treatment.
Despite having universal publicly provided healthcare, many British citizens choose to obtain private voluntary health insurance. In 2015, an estimated 10.5 percent of the United Kingdom enrolled in private health insurance, which offers a more rapid and convenient access to care, especially for elective positions.
The difficult nature of publicly provided healthcare systems in other nations, particularly Canada and the United Kingdom, is that the lack of market competition fails to generate the strongest healthcare options for consumers. Non-urgent and elective procedures are nearly always placed on a waiting list–but who gets to decide what is an “elective” or “non-urgent” procedure? Politicians do! Often, needed hip or knee replacements will even get bumped for months or years down the waiting list. Citizens are evidently frustrated with the lack of holistic care offered through public insurance, as demonstrated through voluntary purchase of private insurance beyond public coverage. An entirely public healthcare system fails to accomplish what it promises–equal and quality healthcare for all citizens.
Closing argument for why a hybrid system is best option
So, what’s the best American healthcare solution? Political leaders on both sides of the aisle loudly proclaim “public healthcare for all!” or “privatization now!” The right answer for now may just be strengthening our existing public-private hybrid system.
Proponents of a “Medicare-for-all” healthcare system–of which there are many, upwards of 75% of polled Americans–typically believe healthcare to be a human right. The reality is, providing a service is not a right in and of itself–the government should not have to force someone to provide the service of healthcare at whatever cost they deem appropriate.
Moving towards an entirely publicly provided healthcare system like a “Medicare-for-all” plan would be devastating to the status quo of American healthcare. A
“Medicare-for-all” system would rid the market of employer-sponsored insurance, which is the way that the majority of working-age Americans receive healthcare coverage. Currently 71% of Americans receiving employer-sponsored insurance say they are content by their coverage.
To provide mandatory healthcare coverage to all Americans, federal spending would need to increase by an estimated $33 trillion in taxes over ten years–or combined payroll and income tax increases of over 20%!
So, who would be paying more for an entirely public system? EVERYBODY. According to a study conducted by The Heritage Foundation, 71% of working families, 85% of taxpaying Medicaid recipients, 66% of taxpaying Medicare recipients, and 65% of young adult workers would be responsible for footing the bill of a universal “Medicare-for-all” system.
As evident by the lengthy waiting lists and cancellations of procedures in the United Kingdom and Canada, entirely public systems in other nations are not the right option for the United States.
Meanwhile, critics of an entirely privatized healthcare system cite concerns about affordability and adequate coverage of vulnerable patients, such as those with pre-existing condition, the elderly, and financially marginalized Americans–reasons that current public programs like Medicare and Medicaid began in the first place.