There is a struggle to provide universal health care because an equitable and affordable way to treat sickness for the rich and the poor is yet to be found. ColoradoCare proposes to provide equitable care. Instead it will anchor an inefficient medical system to the constitution of the State of Colorado.
Prior to the Affordable Care Act (Obamacare), the very sick and the very poor could be denied comprehensive medical services.
In 2010, the Affordable Care Act set out to provide a standard of medical care for everyone. It did so by trying to mandate three things:
1. The requirement that pre-existing medical conditions would exclude no one from coverage.
2. The requirement that everyone purchase insurance or pay a penalty. (The young and healthy would thereby underwrite the old and infirm.)
3. Subsidies for the poor.
The authors of The Affordable Care Act provided special funding to cover the Act’s start-up period. This was needed because many previously uninsured sick and poor people would want remedial care at the outset of the program. However, the planned funding has been insufficient; demand for care has been greater than forecast.
By 2015, insurance companies that had been willing underwriters of Obamacare in 2010 began to reconsider; some have withdrawn. Of 25 health care cooperatives formed to serve new participants 19 have failed, among them the Colorado HealthOp.
All this has happened against the background of rising health care costs.
According to the American Journal of Public Health, in 2013 health spending in the US was 17.4% of GDP. The tax-funded portion was a little more than 2/3 of that total (11.2%.) Average health care spending for OECD countries (Organization for Economic Cooperation and Development, a group of 35 of the worlds most prosperous economies) was 8.8% and 6.5% of GDP respectively. OECD health status data (available here and summarized on Wikipedia here) does not indicate that the US enjoys better health for all the extra cost. (In fact, it receives half the health care for twice the cost. The word ‘scam’ comes to mind.)
ColoradoCare proposes a single-payer system to manage and improve health care for Coloradans. New efficiencies are expected to be found in the administrative areas of billing and claims. Otherwise, costs are expected to grow. (Concerns regarding Obamacare have fueled competing ideas, too. Several current proposals would provide tax credits instead of Obamacare style subsidies, and offer incentives for participation in HSAs (Health Savings Accounts.))
Alas, while these proposals ask the question “How can we most efficiently and fairly cover costs?” they beg the question, “How can we tame the costs themselves?” This is remarkable considering the OECD’s data showing that the US system delivers so much less for more. For the most part, policy makers do not question the price of medications, modalities for training and licensing of health care professionals, monopolistic practices on the part of providers, and monopsony in government purchasing of health care services.
An exception is the Distributist economist John Médaille. In his article, “Distributism and the Health Care System,” published in the Distributist Review, Médaille lists the following concerns:
1. The proportion of GDP consumed by health care costs in the US (17.4% in 2013) is unsustainable.
2. Although technology is improving costs are increasing. This indicates monopolistic pricing. In most cases when the government permits a monopoly (an electrical utility for instance) it sets prices. In the case of health care, the government plays almost no role in pricing.
3. Health care for seniors (Medicare) is socialized. This means that non-seniors must compete with the government when purchasing health related products and services. The government has a monopsony on health care, rather like it has on aircraft carriers. (A monopsony exists when a single buyer controls the market.)
4. HSAs, which permit a tax deduction for health care related savings, are of most benefit to the rich (those with higher tax brackets.)
Then, Médaille offers some ideas to contain the cost of health care:
1. The patent system for pharmaceuticals could be replaced with manufacturing licenses. Developers of pharmaceuticals would license their products to a manufacturer or manufacturers for a fee. The fee would provide a smaller up front profit, but would not expire as a patent does. Returns to the developer would be ongoing, rather than front loaded. Manufacturers would compete on price and service. Speculation in pharmaceuticals, a practice that has received recent attention because of the particularly egregious actions of the owners of Daraprim and the EpiPen, would not be systemically supported as they are now.
2. Medical licensing could be revised to include gradations of care to optimize alignment of medical need with medical service. (The poor must often visit a costly “Emergency Room” because no other service is available to them.) Here is a PBS Newshour report on how this might begin: “Can ordinary citizens help fill gaps in U.S. health care?”
3. Medical training would be provided by stepping through grades of practice (LPN > RN > Nurse Practitioner > etc.) as compensated apprentices. This would permit practitioners to become experienced in administering care as they advanced professionally. A medical doctor could earn her way through her formation, arriving at the M.D. well experienced, and without hundreds of thousands of dollars in student debt to repay.
4. Supervision, training and licensing of medical personnel would be provided by local competitive guilds. Guilds would stand surety for (insure) their members. Medical personnel would buy and own shares in their guild which would establish its own facilities (clinics, hospitals, pharmacies and the like.) Medical operations, training, and supervision would be closer to the communities served. The practice of medicine would be shaped by a community’s response to it.
Médaille’s article is very readable. He does not address the matter of providing care for the poor particularly, but a more rational business model will improve access for everyone.
Whether or not Médaille’s ideas will work shall be determined by testing them. Current patent law is national, if not international. Medical licensing, insurance, and training are at the state level. Impediment to consideration is not concern about an idea’s efficacy; it is pushing past bureaucracy threatened by such innovative thinking. Médaille’s Distributist ideas move the discussion beyond the obedient state of “How can we keep paying whatever is asked?”… a question ColoradoCare, a constitutional amendment, appears to be dedicated to answering … to a reconsideration of our systems, services and practices.
What, then, can be done while awaiting jubilee?
Step 1. Do not support ColoradoCare.
Step 2. Do support an open review of the medical establishment.