The Case for Universal Health Care

 

 

 

The Problem: Insurance-Based Health Care

We all already know the main problems; Health care costs are high, and patient satisfaction is low. But do we all know the root of the problems?

Understanding the Root of the Problem

Health care in the United States is provided by thousands of independently owned and operated health care providers throughout the nation based loosely on free market principles. Specifically, health care providers offer a service and Americans can purchase the services they need. But unlike ordinary products and services in the free market, Americans often seek health care when they are at their most vulnerable, and when seeking services is unavoidable. Most of the time, seeking health care is not really an “elective choice.” And health care services are also unique in that they provide a service, not a product, and these services cannot be exchanged or undone–in most cases–once they have been provided.

When an American buys a faulty product, they have the ability to exchange goods, or to seek a refund for services. But no health care treatment is 100% guaranteed. When a treatment does not meet its intended goal in the health care industry, the patient must purchase additional treatment, see a different professional or undergo additional testing. This means Americans must not only be able to pay for the initial service, but for subsequent and follow up services if the first treatment fails to meet its intended outcomes. While Americans can budget for elective purchases, the need for health care is often unplanned. It is difficult for Americans to plan for a broken leg or cancer diagnosis, and even more challenging to budget for potential follow up services, such as testing, x-rays and additional appointments.

The Insurance Model

To address this unique dynamic in the free market system, the United States has adopted an insurance-based model. But the cost to individual Americans, states and the federal government to support the insurance-based model are staggering. Americans must pay for health insurance through monthly premiums, payroll taxes, and even through other insurance programs like car and homeowner’s insurance. In addition, nearly all insurance policies also require “out-of-pocket” expenses.

In fact, Americans have never been able to afford this system. The United States has upwards of 6,000 hospitals operating independently (note: these figures do not necessarily include additional services such as assisted living facilities, dental offices, mental health care providers and others). This means separate administrative overhead expenses, accountability measures, and department financial management protocols for thousands of providers. The system is not a system at all, but rather a collection of independent agencies that are competing with one another for patients, supplies, services, and funds. The result has always been a higher premium for Americans. In 2008, nearly 1 in 6 Americans were reported to have barriers to accessing health care. And even after the passage of the Affordable Care Act, the needs of 30 million Americans were left unaddressed while cost burdens for working Americans continued to rise. Unfortunately, while intended to address the challenges in the health care industry, the Affordable Care Act only further institutionalized a model that is fundamentally flawed.

The insurance-based model does not work for one main reason. Insurance is designed for things that could but are unlikely to occur. For example, homeowner’s insurance makes sense because a fire is unlikely to occur. Participants in the insurance pool can afford to make lower premiums, and few claims are necessary relative to the pool’s size. However, at this time in human history, human beings are very likely to get sick at some point in their lives. Even those who take the most care of themselves have the potential to experience an accident causing critical injury, or develop a chronic illness, such as cancer. Insurance is not a practical or rational model for things that are very likely to occur.

Fee Per Unit Pricing

The additional challenge with the insurance model is that it establishes a fee-per-unit framework for costs and expenditures in the health care industry. This approach makes sense in a traditional, profit-based business model. However, when applied to health care services, this approach is akin to requiring drivers in the United States to pay not only for each mile of road they travel upon individually, but also for each dotted line, reflector and mile marker they pass on their trip. There is no need to account for health costs in this fashion, however. This is because health care delivery costs are actually formulaic. This means there are fixed costs associated with serving a fixed number of people. For example, to serve 25,000 or 50,000 residents, a single system needs to maintain X number of staff, X number of supplies, X pieces of equipment, and provide X number of treatments. The fact is health care services can and should be delivered using a fixed expense budget to meet the needs of a specific region’s patients based on population size.

Insurance Is a Faulty Product

The final challenge with the insurance model is that it is ultimately a high expense, high risk product. Americans are asked to pay monthly premiums, payroll taxes, high deductibles and copays, and are still subject to treatment and service denial from their providers or insurance carriers. While many Americans do purchase health insurance because there are few, if any, alternatives at this time, the product itself is not logical or practical. It makes sense for insurance providers, but not for patients.

In fact, it is not only personal premiums for health care that are required to subsidize the private health care industry. Americans are required to purchase “hidden” costs as well. Consider for moment the costs associated with automobile insurance, homeowner’s insurance and liability insurance. A significant portion of these insurance products are related directly to subsidizing the private health care industry.

COVID-19 Makes the Case On Its Own

Despite the incredible amount of financial support Americans currently provide to subsidize the private health care industry, the industry is unable to meet the needs of Americans on a regular basis. Millions of Americans forego basic preventative and even life-saving treatment each year, leading to unnecessary deaths and/or costly chronic disease. In fact, despite the incredible expenses Americans pay towards the private health care industry, COVID-19 required the entire nation to issue “stay-at-home” orders to protect an unprepared private sector. And just as importantly, a nation of thousands of independent providers is not coordinated in a way to adequately respond to national crises such as COVID-19. The current model resulted in federal, state and local governments, as well as private providers, competing for resources to serve the people of the United States during an emergency. Many providers are still not given appropriate Personal Protective Equipment (PPE). And today, insurance providers are already asking to raise premiums.

 

 

 

The Solution: Single System Direct Service Universal Health Care

Our goal is to guarantee 100% of Americans have access to high quality, whole-person, patient-centered health care treatment and services, regardless of income, employment status or geographic location by establishing a Single System (Direct Service) Universal Health Care System in the United States.

About Universal Health Care

Universal health care is a premise that asserts a system should be developed to guarantee 100% of Americans have access to basic health care services, regardless of income, employment status or geographic location in the U.S. For many people, the idea of universal health care conjures images of a “nationalized” health care industry. However, the solution is not to nationalize the health care industry, but for the United States to enter the health care industry itself. Much like a grocer provides “generic” or “store brand” goods and products, the direct service universal health care model allows the United States to provide its own “brand” of health care service in the market.

Rather than subsidizing the private market at great expense to taxpayers and employers while still failing to guarantee access to health care for 100% of Americans, the United States has the ability to drive down costs and promote efficiencies in the system by providing a baseline standard of service itself. The single system universal health care model can save Americans and taxpayers far more than the current system, and more importantly, it can guarantee 100% access to services, particularly during a pandemic. It can even ensure the United States doesn’t run afoul of free market principles. 

Getting It Started

To provide direct service universal health care for the United States, Congress needs to establish a single independent agency with a mission to ensure 100% of Americans can access basic health care and life saving services, and that is tasked with providing specific health and mental health services for the American people. This proposal calls for the independent agency to be named the “United States Corporation for Public Health & Wellness” (USCPHW).

This model is designed to allow the United States to guarantee 100% of Americans can access health care services by ending private industry subsidies and replacing the Affordable Care Act and Medicaid/Medicare insurance programs with more efficient, affordable and better health care outcomes associated with direct services offered directly by the United States Corporation for Public Health & Wellness as quickly and efficiently as possible.

Implementation calls for the President and Congress to establish the United States Corporation for Public Health & Wellness as standalone independent agency, or under the pre-existing Department of Health & Human Services. The President, with the advice and consent of the Senate, will appoint a governing board to oversee the agency’s operations made of 15-30 medical professionals, patients, community advocates and liaisons, and others who are committed to the health and well-being of Americans.

Within a matter of months, the board will establish federal wages and benefits for those employed by the U.S. Corporation for Public Health & Wellness, while beginning to convene regional advisory boards across the nation to provide input into essential patient care services. During the process, the U.S. Corporation for Public Health & Wellness can also begin establishing contracts and purchase offers for local facilities. In a matter of 12-15 months (or less), the United States will have its own direct service universal health care system, guaranteeing 100% of Americans’ access to health care, ensuring the ability to coordinate against nationwide pandemics, and eliminating staggering health care costs for local and state governments and the American people as a whole.

United States Corporation for Public Health & Wellness: What Will It Provide?

The U.S. Corporation for Public Health & Wellness will provide to every American, at minimum:

• 1-2 physicals or wellness exams each year, which include basic lab tests and preventative screenings
• Individualized wellness and illness prevention plans, as well as preventative treatment for known diseases such as vaccines, antibiotics, etc.
• Examination and consultation to determine root causes of illness or injury when patients present with issues or complaints, including relevant x-rays, labs and additional testing as needed
• Recommendations for treatment and prevention, including prescriptions for specific drugs, surgeries, or referrals for specialized services, including social services, mental health services, physical therapy and others
• Surgical or other physical procedures to address immediate bodily injury, illness or trauma
• On-going treatment as needed for chronic illnesses, such as cancer, heart disease, diabetes, kidney failures, etc.
• Basic dentistry and vision services
• Mental health counseling and addiction treatment services
• Supported living facilities
• Medically-related transportation
• Prescriptions fulfillment, research and development
• Equipment (technology) creation and acquisition

A Regional Approach: Determining Essential Services and the Therapeutic Framework

To deliver these services, the United States Corporation for Public Health & Wellness defines population-based health service regions of 50,000 or 25,000 which establishes approximately 6,600-13,200 centralized hospital and related facilities regions across the United States (similar to the current amount of hospital facilities already in existence). Each region is equipped with the appropriate staff, supplies and medical technologies to completely serve their region and provide the basic and essential services included in the Congressional mandate for the United States Corporation for Public Health & Wellness.

Within a matter of months, the United States could have its very own direct service universal health care system, even rivaling models of other nations. Advisory boards and commissions for each health service region made of medical professionals, social workers, researchers, patients and other health industry and community stakeholders ensure the most up-to-date advancements, and the continuous incorporation of best practices in the field. In addition, these regional advisory boards can help the United States Corporation for Public Health & Wellness codify services that need to be considered “essential”. For example:

• Patient Navigation Services
• Chiropractic care
• Massage therapy
• Wellness Coaching
• Dentistry
• Vision
• Mental Health
• Addictions Treatment
• Emergency Medical Transportation
• Non-Emergency Medical Transportation
• Supported/Assisted Living Facilities
• Social work services
• Prescriptions
• Chronic illness treatments
• Trial vaccines and treatments
• Trauma-Informed Care and Services

Regional advisory boards can also address systemic disparities and help to encourage continuous innovation in therapeutic approaches that, when proven successful at the local level, can benefit Americans across the nation. As a single, independent agency with local advisory boards, the United States Corporation for Public Health & Wellness competes with itself to provide the best services rather than with other hospitals or medical providers. In addition to the traditional medical model, regional advisory boards can also help introduce the most cutting-edge, whole-person approaches to health and wellness, to include new staffing models that promote employee wellness and satisfaction, in addition to patient outcomes. 

Budget: How Will It Be Funded?

The most equitable way to guarantee adequate funding for the United States Corporation for Public Health & Wellness is for the United States to initiate a federal sales tax. This ensures all Americans have ownership over the system and participate in the funding of the service, regardless of employment or income status, or geographic location within the United States.

A flat rate sales tax of 10%, or a tiered-rate sales tax of 5-15%, would provide an initial budget of approximately $2 trillion per year under normal U.S. GDP estimates (specifically including the sale and transfer of stocks). As importantly, this payment model alleviates the monthly subscription and income payment-based burden from American workers and fixed-income retirees.

Consider for a moment the United Kingdom’s National Health Service (NHS) budget of £120 billion, which equates to approximately $145 billion in the United States. This budget allows for the NHS to provide health care services for upwards of 66 million people. To provide a similar service in the United States, scaled for population size, the United States would need to provide five (5) times the funding, or $725 billion to serve approximately 330 million Americans.

A $2 trillion budget would advance the United States’ health care system beyond anything available today. It would allow the system to provide for chronic treatment, prescriptions, medical and mental health care, assisted living, and even medically related transportation. The initial budget would also allow for the United States to purchase existing facilities from the private sector, or to build new facilities as needed to serve 100% of American communities.

Sample Year 1 Budget for the United States Corporation for Public Health & Wellness

The USCPHW will have an initial annual budget of $2 trillion. 

Staff: $700 billion*
Facilities: $300 billion**
Medical Equipment/Supplies: $500 billion***
Drugs: $500 billion****

*An average salary of $75,000.00 per year would allow the United States to employ 9.3 million health care professionals, which also includes auxiliary workers such as medically-related transportation providers, health care aides, and more. **Building two brand new hospitals in each state per year would still be less than the allocated amount. ***This budget allows the USCPHW to not only purchase equipment and supplies, but to continue to invest in research and technology development to ensure Americans receive the best and latest technologies. ***This budget would allow USCPHW to not only provide many prescriptions and treatments at no cost to patients, but to invest in continued research and development of treatments, vaccines and other medicines. 

Key Benefits of the New Funding Model

Specifically, a federal sales tax model eliminates several cost burdens for Americans, taxpayers, employers, states and the United States government. The direct service universal health care model eliminates the Medicare tax, the need for Medicaid, monthly insurance premiums, co-pays, “out-of-pocket” expenses, service and treatment denials, and “hidden costs”, such as higher auto and homeowner’s insurance policies. In addition, as Americans are guaranteed health care services regardless of employment, income or geographic location in the United States, employers have the opportunity to turn current health care benefits into direct wages.

Perhaps one of the most important benefits, however, is the removal of what is known as perverse incentives from the health care industry. Specifically, health care providers in the private industry earn income when people are sick. This means they have no choice but to rely on illness and injury to earn a profit. The United States Corporation for Public Health & Wellness, on the other hand, is the one business in the United States that has a vested financial interest in keeping people healthy. This means it must provide the most effective and efficient services to ensure Americans get back to good health as quickly as possible. Simply put, by providing high impact prevention and basic services, the United States will save money by keeping people healthy. Shareholders, which in this case would be taxpayers, celebrate when the United States Corporation for Public Health & Wellness can lower taxes and decrease its budget because so many Americans are healthy and well.

 

 

 

FAQ’s – Dispelling Myths and Fears

Universal health care has been shunned in the United States primarily due to huge amounts of fear and industry and special-interest generated misinformation. Direct service universal health care ensures 100% of Americans, regardless of income, employment status or geographic location can receive the treatment they need. And, it can do so far more affordably and efficiently than the insurance-based model.

Is Universal Health Care a form of Socialism?

It’s important to understand terms like capitalism, socialism, communism and fascism. In today’s world of social media, these terms are often used loosely and incorrectly. In fact, capitalism calls for implementing the most cost-effective, efficient services. In this case, a direct service universal health care system owned and operated by the United States answers capitalism’s requirements because it inevitably is more affordable, and has more readily predicable outcomes.

Single System Direct Service Universal Health Care is the best “capitalist” choice.

Capitalism calls for businesses and governments to utilize the most innovative, efficient and affordable mechanisms to meet their goals. The insurance model drives up costs for Americans and requires ever-increasing government and taxpayer subsidies. In order to reduce costs, ensure 100% of Americans can access health care, and to support public health (particularly during large-scales events such as COVID-19) the direct service universal health care model is the best strategy. In fact, it is capitalism itself that calls upon the United States to enter the health care market.

What about Medicare for All or Single Payer?

“Medicare for All” is a form of universal health care insurance, not universal health care. As with the current insurance-based model, this means costs are likely to continue to rise for governments and taxpayers. In addition, “Medicare for All” does not provide for a coordinated system, which means in cases like COVID-19, private providers would still be competing with other providers, as well as federal, state and local governments, for equipment, funding and supplies. A direct service universal health care system eliminates the challenges associated with insurance-based models, including the inability for private providers to coordinate nationally during a pandemic.

Similarly, “Single Payer” is neither a health care service nor health insurance. It is an expensive, consolidated accounting system that presents challenges to private providers and patients. Both “Medicare for All” and “Single Payer” require vast government and taxpayer subsidies without guaranteeing health care services for 100% Americans. Direct service universal health care is the only model that will guarantee 100% of Americans can access health care services regardless of income, employment status or geographic location, and allows for rapid, real-time national coordination efforts in the face of a pandemic like COVID-19.

But what if I don’t want to pay for other people’s health care?

It is important to remember this model is a universal health care system. Taxpayers pay for the system to be available to all Americans, including themselves, rather than for an individual’s personal needs. The model is similar to federal, local and state transportation systems. When Americans pay gas taxes or vehicle registration taxes, they are paying for the transportation system to be available, not for another individual’s transportation. Subsequently, a person is then able to use as much or as little of the transportation system as they need. In addition, because the direct service universal health care model is based on a federal sales tax, everyone chips in. Even a person who receives an allowance contributes to the health care system when they purchase a pack of gum.

But wasn’t there concern about Veterans Administration (VA) hospitals ran by the United States?

It is likely a better model for local communities to employ professionals who specialize in Veteran Care than to have a separate system. This ensures Veterans receive a baseline standard provided to all Americans, as well as specialized care necessary to address Veteran-specific concerns.

There is already a shortage of medical professionals. How would this impact that problem?

By establishing a health care system that allows medical professionals to focus on patient care and medical and mental health care advancements, rather than profit-based outcomes, the health care industry will likely see an increase in interested professionals. In addition, by establishing a robust health care system, the United States will be able to provide employee incentives that might not currently be available to private-sector employees. For example, the United States military often provides for tuition-reimbursement or student loan payoffs when members enlist for certain periods of time.

Health care is not a right; How can we be entitled to other people’s labor?

Unfortunately, this concern is often used out of context. Using the same line of thinking, it could be said the United States should not have a military. However, the United States has chosen to provide this service, and thus, pays those who serve. The same is true for a direct service universal health care system.

Won’t private providers be put out of business?

No. It is possible many hospitals and private practices will be bought out by the United States Corporation for Public Health & Wellness. However, those who work in the health care industry are likely to continue to do so. As importantly, they are likely to work in environments that provide greater protections and economic security than the previous model.

It is also likely new business models will emerge. For example, there are doctors today who only charge $35.00 per visit. However, labs, x-rays and other tests are often additional expenses which present challenges for patients who need to take advantage of lower cost providers to begin with. A direct service universal health care system will allow more private doctors to operate this way, or similar, because additional tests and even prescriptions will be provided by the United States Corporation for Public Health & Wellness. Simply put, the establishment of a direct service universal health care system will allow even more private practice providers to enter the market because additional needs like labs, x-rays, etc., will be covered by the direct service universal health care system.

In addition, there will always be Americans who prefer to do business with small or private providers simply because they do not want to do business with the government. This will remain a cornerstone of the United States’ free market system.

Consider for a moment the United States Postal Service. Because the USPS provide the main infrastructure for mailing and delivery services across the country, private sector businesses like FedEx, UPS and many others can operate and compete in the market. This is what the USCPHW can do for health care as well.

What if I don’t want the government to have my medical information?

Establishing the United States Corporation for Public Health & Wellness as an independent agency of the United States creates a barrier between the “government” and the service. For example, when you use the United States Post Office, the government is not entitled to read your mail. HIPAA and 4th Amendment Protections still apply, and likely even more so, to the United States Corporation for Public Health & Wellness. In addition, lawmakers can establish additional shields between medical information and public records.

What if I like my current insurance (or Medicare/Medicaid)?

Unfortunately, the current insurance model must be subsidized by taxpayers, as well as other industries, at great expense. In addition, the insurance model still leaves more than 30 million Americans uncovered. This means in order to keep the current insurance model, millions of Americans, including children and families, face chronic illness and even death each year. There is no reason for any American to suffer when a more holistic, efficient and affordable model is available.

What about currently “controversial treatments”, such as abortion, or gender affirming care?

Universal health care is designed to ensure access to basic primary health care services, life-saving procedures and ethical treatments (including mental health care services) for 100% of Americans. The United States Corporation for Public Health & Wellness will need to establish protocols for determining what is “essential”. It should be noted, however, that other countries view many “controversial treatments” in the United States as basic health care in their national health care systems already.

What about death panels?

In the 2008 elections, during the last major health care reform movement, many people spoke about “death panels” in which they envisioned politicians sitting around trying to determine who should or should not get care. Ironically, this is actually what happens today with medical professionals often being called up to make decisions based on payer, rather than patient needs. The United States Corporation for Public Health & Wellness answers directly to the American people, and is guided by a governing board, and thousands of regional advisory boards which eliminates the possibility of “death panels”. Patient needs and health outcomes are automatically able to be prioritized over payments.

Other countries have nationalized health care, and some people don’t like it, or they have to wait for treatment. How do we address that?

In the United States, if an American does not have access to private or public health insurance, they could be made to wait forever, and this includes many of America’s most vulnerable populations. The U.S. Corporation for Public Health & Wellness (USCPHW) addresses many of these concerns by becoming a part of the industry, rather than “nationalizing” it. In addition, the USCPHW has the ability to learn from other nations and avoid potential pitfalls at the outset.

Wouldn’t it be better for states to do this, rather than the federal government?

If some states provide universal health care and others do not, this means the federal government will still be called upon to fill in the gaps. For example, if a person living in Colorado traveled to Ohio for vacation and became ill during the trip, how would their Colorado-only universal health care be used to pay for services in Ohio? In addition, COVID-19 demonstrates that having 50 (or more when including territories) health care systems competing for supplies and services is not beneficial to the health and well-being of the American people as a whole. The United States Corporation for Public Health & Wellness addresses all of these concerns.

It will cost too much, won’t it?

No. The Single System Direct Service Universal Health Care Model is the most cost effective model, and saves Americans and taxpayers money. In fact, it removes all of the following:

• Medicare/Medicaid Payroll Taxes
• Monthly health insurance premiums
• Annual out-of-pocket expenses
• Co-pays
• Health coverage included in auto and homeowner’s insurance
• Other hidden health care charges

But “they’ll never do it”.

The “they” is us. If you want a single system direct service universal health care system in the United States, it only takes 5 minutes to call, email or send a letter to your U.S. House Representative and U.S. Senators. Take the time to do it today.

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