Ep 02: Overview Of Various Healthcare Systems

Welcome back to the Let’s Fix It series about the American health care system. I’m Dr. Chris Robertozzi, a practicing podiatrist in Newton, NJ. This podcast will review various health care systems. They all have the potential to get us to our desired goal. Regardless of what finally comes out of the discussions, there will be compromises and some creative twists to make the new system function better. Your input is important. Please go the website www.betterhealthcarereform.com. In the upper right-hand corner of the screen, click on Contact Us and share your ideas with me so that I can bring them to the meetings. As mentioned in the first podcast, the United States is the only high-income country that does not guarantee health care for its citizens, nor does it have universal health care. So, let’s start with the pros and cons of universal health care. That is where every citizen is covered for basic health care needs run by the government.

The pros for universal health care system are that catastrophic, emergent and urgent illnesses are covered. These tend to be the most expensive for the patient in the fee for service model leading to large medical bills. Other medical care is covered too but not every service that is provided by physicians is part of universal health care coverage. Second, you are covered regardless of your health history. Third, no one is left without some basic health care.

The cons for universal health care are more extensive. The biggest misconception is that universal health care is free. Nothing could be further from the truth. It is paid for through a health care surcharge that is taken out of your paycheck. It is usually a percentage of your gross wages in the range of 20-30 percent. The rates are set on a national basis. Those who do not work are not paying into the system. Those individuals are supported by the government and those who contribute through their payroll health care surcharge.

Second, while treatments for catastrophic, emergent and urgent illnesses are covered, that does not mean that you will get cutting-edge care for that disease. Third, elective procedures, such as knee or hip replacements, have long waiting times to be performed. Authorizations are usually required for elective procedures before they can be scheduled. Fourth, universal health care does not cover every physician service. Fifth, the services in health care that are provided at any given time are based on the amount of money in the budget for that treatment. Sixth, many individuals purchase private insurance which adds to the overall cost to the individual. Seventh, there is no choice of insurance carriers if it is government run. Eighth, there is no competition. Ninth, if you are working, you don’t have a choice whether the money is taken out of your paycheck.

The term single payor system is often used synonymously for universal health care. However, a single payor system means there is only one insurance carrier. It does not mean that everyone is covered. It can be run by an insurance company that is contracted to provide the services and not the government. The pros are that the system can have whatever options are decided on by those designing the system. Second, the payment method is open-ended. Thus, it can be paid by a health care surcharge on everyone’s paycheck, paid for by the employer, paid for by the individual who doesn’t work, or a combination of the ways listed. For instance, both the employer and employee can contribute to the payment. It can be a set fee or percentage of the paycheck.

The cons for a single payor system are that there is no choice of insurance carriers. Second, there is no competition. Third, not everyone is covered.

Managed care is the present system in the United States and has been for the last few decades. In its present format, it has brought us to our atrocious ranking. Doctors and patients decide on the treatment plan that works best for them. The insurance company decides how much they will cover. The physician submits a bill for the services provided. The insurance company decides what they will pay. The pros are that managed care keeps the cost of health care down by not allowing “medically unnecessary” treatment.

The cons are the administrative burdens to control the care provided are costly and time consuming, thus taking staff away from caring for patients to do paperwork. This increases the cost of care by having staff to do all the extra paperwork. Second, networks limit patient choice on who they can see for their care. Third, the cost has gotten prohibitive in most cases for individuals who pay for their own health care insurance.

The up-coming trend is value-based reimbursement in the managed care system. This has potential to bring costs down. However, to be fair, the patient’s contribution to the care must be incorporated in the calculations. For instance, the physician can make the correct diagnosis, order the right tests and medication but if the patient doesn’t take responsibility for their part of the care such as taking the medication as prescribed or showing up for appointments, the outcome will be poor. This affects the overall quality of care that is provided in our health care system and the level of reimbursement. That is not how we want the system set up in the future or we will not be able to reverse our world ranking. Both the patient and the provider must work together with a common goal. Part of the dilemma goes back to affording the medication or getting a ride to the provider’s office. These issues must be addressed to improve the overall health of Americans.

Fee for service is where the United States started with health care. Health care has been criticized as not having any competition and thus the cost continually goes up at unprecedented rates. Every business that provides professional services can charge whatever they desire. With the plumber and the electrician there is competition because the individual that is requesting their services is paying the bill. Those requesting professional services will shop around and see who will do the best job for the best price. On the other hand, health care providers are presently paid by a third party that determines what they will pay for the service. So, the system presently alleviates competition the way it functions. One way to bring the prices down is to introduce competition back into health care. The pros are the system will introduce competition back into health care both at the level of the provider and the insurance company. If the patient knows what the provider charges and what the insurance company pays for the services they use most, the patients will be selective about what insurance they purchase and what providers they see. It will eliminate a lot of the administrative burdens. The patient can select the care they want if they know the costs and reimbursements.

The cons are that not everyone is covered. The costs for emergent and urgent care could get expensive for the patient.

I truly believe that a fair system can be designed for the United States that can get us delivering the best health care in the world. I have several ideas to make it better that I will divulge at the Zoom meetings. The reason for not sharing them now is that I don’t want to stimy the creativity of others by proposing solutions now which can bias their thought process. It is likely that someone out there may have better solutions than me. Your solutions are important. Please share them with us through the website: www.betterhealthcarereform.com.

If you want a better health care system and think that what I’m proposing will get our country there, then contact the organizations that I will mention and request that they send a representative to the Zoom meetings to start on February 5, 2025, at 4:00 pm EST. They have all been sent an invitation for the proposed collaboration on health care. I will provide the name and phone number of the various organizations at the end, but you can see all the organizations and their phone numbers on the website: www.betterhealthcarereform.com. It is appropriate if no one answers the phone to leave a voicemail. A simple statement such as please participate in Let’s Fix It health care reform Zoom meetings starting February 5, 2025, at 4:00 pm EST. Feel free to give your name and any other pertinent information you are comfortable sharing. The listed associations received a letter in December with all the details.

Those who attend will rewrite the health care proposition that will be sent to Congress to make the appropriate changes whether it is a law or alterations in the delivery of health care. A summary of each meeting will be posted on the website within a few days so you can keep up with the progress and provide feedback. Likewise, the recommended changes that will be sent to Congress for approval will be posted.

The Affordable Care Act took 26 months from the time President Obama took office until it was passed by Congress on March 23, 2010. It was not implemented until January 1, 2014, 45 months later. Our goal is to write the proposal, pass Congress and be implemented in less than six years.

The following are the names and phone numbers of the organizations that need to be contacted to participate in the Let’s Fix It Zoom meetings for health care reform.

American Academy of Physician Assistants: (703) 836-2272

American Association for Respiratory Care: (972) 243-2272

American Association of Nurse Anesthesiology: (847) 692-7050

American Association of Nurse Practitioners: (512) 442-4262

American Chiropractic Association: (703) 276-8800

American Dental Association: (312) 440-2500

American Health Care Association/National Center for Assisted Living: (202) 842-4444

American Hospital Association: (202) 638-1100

American Institute for Medical and Biological Engineering: (202) 496-9660

American Medical Association: (312) 262-3211

American Nurses Association: (800) 284-2378

American Osteopathic Association: (312) 202-8000

American Occupational Therapy Association: (301) 652-6611

American Physical Therapy Association: (800) 999-2782

American Podiatric Medical Association: (301) 581-9200

American Public Health Association: (202) 777-2742

America’s Health Insurance Plans: (202) 778-3200

National Association for Home Care and Hospice: (202) 547-7424

National Patient Advocate Foundation: (202) 347-8009

National Pharmaceutical Association: (480) 405-9291

Thank you for taking time out of your day to listen to this podcast. Please share this with your family and friends and let’s all work toward a better health care system for all American citizens. Please contact the organizations and let them know that you would appreciate their participation at the Let’s Fix It meetings so we can achieve a better quality of health care for all Americans and reverse our rank in health care in the world

Ep 02:

Overview Of Various Healthcare Systems

TRANSCRIPT