By Kate de Klerk, OMS IV, and Mayra Salazar, OMS III
The DO, Opinion, July 17, 2018
The Student Osteopathic Medical Association is asking the House of Delegates to take up an important question: should AOA support a “Medicare for All” single-payer health care system? Support is steadily growing in the U.S., with a majority of Americans and many physicians indicating that they support a single payer health care system.
This is a controversial topic and some may consider support for a single-payer system naive and idealistic. However, we invite you to suspend any skepticism and engage in this conversation with us.
As DOs and medical students, there is probably much more that unites us than divides us. As students, we want to work in an efficient health care system, but not one where arbitrary cost-cutting trumps clinical judgment and evidence-based approaches to care. We want to see equitable distribution of resources in health care, but when many DO students’ debt burdens are over $240,000, we also want to protect wages so that we can pay back loans and achieve financial stability.
Issues in the health care space are multi-faceted and Medicare for All is not a panacea. However, we think this shift would greatly benefit both patients and providers.
A fundamentally flawed system
Health care is exceedingly complicated and prohibitively expensive for patients. Despite many positive changes introduced by the Affordable Care Act, patient satisfaction with health insurance reached a 10-year low in 2015, according to the American Consumer Satisfaction Index, with many patients reporting that they don’t understand their health plans.
Our current system is also unaffordable for many Americans. As high-deductible, high co-pay plans become the norm in health care, 29% of patients with high-deductible plans report not seeking care because of cost. A system that discourages patients from getting care when they need it is fundamentally flawed.
The current system also presents challenges for physicians. Physicians report that they are spending more time on paperwork and less time interacting with patients. In 2017, 70% of physicians reported spending more than 10 hours on administration per week, with 32% of doctors spending more than 20 hours.
A 2014 study estimated that billing and insurance-related costs in health care were roughly $471 billion annually, a number that has grown exponentially since the 1970s. Physicians also experience frustrating limitations placed upon them by insurance companies, with formularies dictating treatment plans, rather than medical best practices or clinical judgment.
How Medicare for All would work
The current Medicare for All plan is outlined in House (H.R. 676) and Senate (S. 1804) bills that would expand and improve Medicare. In brief, this would be a publicly funded, privately operated health care system. The system would introduce universal coverage, spreading cost and risk out among all taxpayers. It’s predicted that a majority of Americans would spend significantly less on health care each year than they currently do. The proposed system would do away with co-pays and deductibles, and patients would have autonomy when choosing their health care providers. Physicians would benefit from simplified administrative processes and have greater autonomy in treating patients.
There are many strong arguments in favor of a single-payer system, but for us it comes down to this: the incentive structure of the current system isn’t working.
Health insurance companies are by-and-large for-profit, with inherent tensions between the provision of health care and the goal of maximizing profits. A quick look at the Fortune 500 reveals that the business of health insurance is one of the most profitable industries. UnitedHealth ranks fifth on the Fortune 500, ahead of Amazon.com at #8 and Alphabet (Google) at #22.
Insurance companies are not lean operations. They are large bureaucracies that have increased inefficiency in the health care system and deprioritized health outcomes. It is thought that switching to a single payer system would save roughly $200 billion annually by eliminating overhead costs alone and also reduce billing and paperwork expenses. Rising out-of-pocket costs and decreased usage of the health care system help a company’s bottom line, but have dangerous consequences on the health of Americans.
People over profits
When compared to other developed nations, the United States consistently ranks near the bottom for most health metrics. While there are interesting disruptors entering the market, such as Oscar and Collective Health, a for-profit system will never yield the kind of efficiency and equitable distribution of health care resources that we think are possible.
A Medicare for All system is also unlikely to result in major sacrifices on the part of providers. Various economic projections suggest that, for most physicians, transitioning to a single-payer system would not significantly impact income or satisfaction in the long-term.
We think that movement toward a Medicare for All system is inevitable. Perhaps it will look different than the current bills, but there is a groundswell of support for a system that places people over profits. The question members of the AOA House of Delegates should ask themselves is, do you want to be at the forefront of this change, or will you sit back and wait for others to lead the way?