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Thursday, February 08, 2007

Affordable Health Care for All?

Wal-Mart and some of it's biggest union critics got together yesterday to "push the debate forward" on universal health care.

Like Barack Obama stating last week that by 2012 if he were President we would have universal coverage, Wal-Mart and the Service Employee's International Union gave no indication how such coverage would be paid for.

The truth is, even if a magic spigot of money was found to make universal health care affordable, it still wouldn't be available. We don't have enough general practice doctors, or nurses of any type, especially the advanced practice one's that would be necessary, to provide easily accessible health care for everyone. That problem can't be fixed in 4 years, it'll take at least 10, if they can find a way to get folks into the medical profession.

Getting people into that profession has become harder and hard over the last 3 decades due to the rising cost of malpractice insurance, and the low reimbursment rates for current government medical programs.

While Medicare provides a great stream of patients for doctors as the population ages, it doesn't pay enough to cover the expenses incurred. A universal system would have to have a higher reimbursment rate to cover those expenses, unless of course tort reform was also going to be part of the package. My guess is that the Democrats who control congress won't go for that very quickly.

Some advocate a Canadian style system, but it's probably as unaffordable as any other. In 2006 the Canadian government collected 42 billion Canadian Dollars (34.4 Billion US) to from their GST, which covers their national health care system for a populaltion of about 32 million.

Even if we could immediately duplicate their system, we'd need to find about 10 times that amount of money (340 billion) to pay for a universal system here, annually. Considering Medicare alone will spend more than that for FY 2007 ($395 billion) it's hard to see how we'd get a Canadian style cost overnight that would cover 320 million people, and not cost a trillion a year.

In fact, with 41 million people on Medicare, you can compare it's numbers to the Canadian numbers, and see our federal health insurance plan is spending 10 times the money per patient as theirs. Granted, Medicare is nearly all eldery people, who do have higher costs than the young to cover, but still, it's a good starting point to figure out costs.

So, how do we get to universal care, without going bankrupt?
  1. Well first you have to get the American population that currently has insurance (85% of us) to accept reduced services, and less choices in care
  2. You also have to get us to accept some sort of tax increase to pay for it. If you can't show the tax increase is less than what we'repaying for insurance, it's gonna be a tough sell.
  3. You have to get the medical establishment to agree to move more doctors and nurses out of specialties (which currently pay more) and move into general practice, where there would be a greater demand.
  4. Then you have to get them to accept lower payments for their services, which probably will be tougher than getting them to move to general practice.
  5. You also have to get lawyers, and the politicians beholden to them, to accept tort reform. Until malpractice insurance premiums come under control you won't see doctors accepting number 3. (An Ob-Gyn in the DC Metro area can expect to pay between 84,000 and 134,000 a year in malpractice premiums).
  6. Drug companies will have to accept lower payments for newer drugs. Considering the US is just about the last place in the world to recover R&D costs on medicines, expect new medications to show up much more slowly because of it. (Europe has seen it's share of the new drug market drop by over 50% since they instituted price controls).
  7. Congress will have to convince people that a government beaurocracy can control costs. History makes that one a pretty tough sell.

So what else can you add to my list of things that have to be sold to the population before "universal health care" can become a reality?

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