In our last few blogs, we have set the stage for a deeper conversation on Medicare For All (MFA). We have looked at some of the macro and micro numbers, and there is a bit more to explore. In our upcoming blogs, we will dive further into potential costs and ways to pay for MFA, as well as suggest some real tangible ideas on three “must do” items:
- Expand healthcare coverage to those not covered today
- Lower the cost of care
- Improve healthcare for our society
The fact is, anyone that does not propose doing all three of these items, is ultimately proposing something that will not work in the end.
Just for a moment, let’s look at other countries with single payors or socialized medicine…
Some of the examples mentioned repeatedly are Northern European countries like Norway, Finland, and Denmark. Two others that I’d like to add are Canada (CN) and the United Kingdome (UK), mainly because we can read their information easier.
I could also talk about my birth country, Cuba. Cuba’s healthcare is the subject of much referenced relation to the U.S. in print and in media. As is the case with most conversations about Cuba, what tourists, journalists and people who live outside of that focus, see and experience are very different from reality. I will say that from actual experience of people who have been there and been treated, the fact that you have “healthcare professionals” in surplus, and healthcare is free, does not mean that healthcare is even remotely comparable to 90 miles north of Havana. I have friends who have experienced healthcare in Cuba. They informed me that there were a lot of attendants and doctors however, in all cases, they did not have tools, diagnostic equipment and lacked the basic medical supplies every doctor’s office has in the U.S.; not to mention what is available at hospitals in the U.S. I have witnessed this lack with my own eyes.
In the U.S., I expect that if we chose to create an MFA to have a fully bifocaled system of care (that seems to be the developing case in the UK and CN) one where the wealthy will choose private care, and/or come to the U.S. for treatment, versus sometimes waiting months to be treated.
In the UK, a country with 66 million people expending approximately $4,200 (USD) per capita for their Universal Healthcare program, that’s about 50% less than the per capital in the U.S. There are clear values in a universal health program, and there are challenges. Some of those challenges are time to receive care or treatment, lack of personalized options, employed medical staff (nurses and doctors), long waiting periods for procedures and surgeries, and bureaucratic challenges.
For example, 7% of the population of the UK are on active waiting lists. On average, 350,000 wait longer than three (3) months for treatment; 90,000 waited longer than six (6) months and thousands wait longer than one year for treatment. One amazing fact we discovered is that 9% of all physician posts (capacity needed) remain unfilled; that is a shortage of 11,000 physicians. Let’s remember, it takes about 10 years of post-secondary school to produce a medical doctor.
In Canada, the median waiting period to see a specialist after referral is 10 weeks, and the time between diagnosis and treatment can be months. The average Canadian can wait up to three (3) months to visit an ENT and four (4) months to see an orthopedic – even longer to see a neurologist. Normally if you need to see a neurologist, it is important to be seen in a more timely manner. I lived that scare last year with a family member.
In certain areas of the U.S., we have long waiting times; however, nothing like CN or UK. The surveys tell us that the average is 21 days to see a specialist; something I have also experienced.
I personally know Canadians that pay for private U.S.-based health insurance to handle any priority care they could need and receive service in Detroit (MI), Buffalo (NY), Boston (MA) or even New York City.
Excessive waiting times are unacceptable to Americans who have healthcare insurance provided by their employers. Furthermore, it’s also unacceptable for those covered by Medicare, who also have access to on-demand care for needs.
Our intent is not to diminish the value of other systems that have worked for more than half a century. If America had made the transition to a more socialized system after World War II, it could have worked in the 1950s and even up to 1965 when Medicare and Medicaid began. Today, we think it is impossible.
Most of the countries that adopted a single payor after the Second World War were able to benefit from an exploding population boom and a relatively young population with modest demand for healthcare and growing economic power. The growth of Japan, Germany, France, Spain and the UK post-war was an economic miracle. However, we are now on the back side of the Baby Boomer wave and the developed world is aging fast. The last time I checked, the median age in Japan was about 45 years old; EU was 42 and the U.S. was 38, and aging. Japan, EU in general, and the UK are facing material pressure on medical cost. The cracks are showing, as waiting lines grow. Canada and the UK have a private fee-for-service alternative emerging.
The U.S. continues to have the base of private systems with two huge government sponsored programs and we lead in innovation and technology.
We need to focus on the solutions that free markets, as well as innovations and technology that can and currently are, bringing to the market. The American consumer has never been more connected, engaged and demanding. In fact, one of the best ways to change the healthcare problems is to empower the consumer even more – technology is the only way today to do that!
In our next blog, we will continue to explore how a proposed MFA will impact the healthcare and health industry in the U.S., as well as how the impact can impact both access and cost.