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Medicare for All

Access to quality healthcare is one of the most important factors in overall well being, and yet America is one of the few industrialized nations not to provide healthcare for all of its citizens. Instead, we have a private healthcare system that leaves millions uninsured and bankrupts even some of those who do have health insurance. At the same time, our cost of care is higher than in almost any other industrialized country while providing worse outcomes. The Affordable Care Act was a step in the right direction, providing funds to states to innovate while expanding Medicaid substantially. However, it didn’t address the fundamental issues plaguing our healthcare system:

  1. Access to medicine isn’t guaranteed to all citizens
  2. The incentives for healthcare providers don’t align with providing quality, efficient care

This must change.

Through a Medicare for All system, we can ensure that all Americans receive the healthcare they deserve. Not only will this raise the quality of life for all Americans, but, by increasing access to preventive care, it will also bring overall healthcare costs down.

With a shift to a Medicare for All system, costs can also be controlled directly by setting prices provided for medical services. The best approach is highlighted by the top-ranked Cleveland Clinic. There, doctors are paid a flat salary instead of by a price-for-service model. This shift has led to a hospital where costs are visible and under control. Redundant tests are at a minimum, and physician turnover is much lower than at comparable hospitals.

Doctors also report being more involved with their patients. Since they’re salaried, there’s no need to churn through patient after patient. Instead, they can spend the proper amount of time to ensure that each patient receives their undivided attention and empathy.

Outside of a shift to a Medicare for All system, we can look to the Southcentral Foundation for another important shift necessary in the way we treat patients: holistic approaches. At this treatment center for native Alaskans, mental and physical problems are both investigated, and, unsurprisingly, the two are often linked. By referring patients to psychologists during routine physicals, doctors are able to treat, for example, both the symptoms of obesity and the underlying mental health issue that often is related to the issue. The referral also leads people with issues they may otherwise try to bury – sexual abuse, addictions, or domestic violence issues – to bring them up with a doctor so that they can be addressed.

By providing holistic healthcare to all our citizens, we’ll drastically increase the average quality of life, extend life expectancy, and treat issues that often go untreated. We’ll also be able to bring costs under control and outcomes up, as most other industrialized nations have.

Finally, being tied to an employer so that you don’t lose your healthcare prevents economic mobility. It’s important that people feel free to seek out new opportunities, and our current employee-provided healthcare system prevents that.

Healthcare should be a basic right for all Americans. Right now, if you get sick you have two things to worry about – how to get better and how to pay for it. Too many Americans are making terrible, impossible choices between paying for healthcare and other needs. We need to provide high-quality healthcare to all Americans and a Medicare for All system is the most efficient way to accomplish that. It will be a massive boost to our economy as people will be able to start businesses and change jobs without fear of losing their health insurance.

Problems to be Solved

  • Millions of Americans live without healthcare.
  • Even those with healthcare are often bankrupted by healthcare costs.
  • Many Americans who have healthcare have policies that don’t afford them the opportunity to receive proper care.
  • Healthcare costs in this country are relatively high, and outcomes are relatively poor.
  • Doctors are incentivized to act as factory workers, churning through patients and prescribing redundant tests, rather than doing what they’d prefer—spending extra time with each patient to ensure overall health.
  • Many health issues fall through the cracks because doctors rely on patients to bring up issues rather than treating each one holistically.
  • Employees are tied to their employers because they receive the healthcare benefits through them.
Guiding Principles:
  • Quality of life
  • Innovation
  • Holistic healthcare
  • Freedom
Goals
  • Holistic healthcare for all Americans
  • Bend the cost curve of healthcare down
  • Focus on preventive and holistic care
  • Change the incentive structure for doctors
  • Allow doctors and hospitals to innovate in treatment

As President, I will…

  • Work with Congress to create a Medicare for All system to provide healthcare to all Americans.
  • Shift the way doctors are compensated to promote holistic and empathic care.
  • Create incentives for and invest in innovative treatment methods and methodologies.

An Excerpt from The War on Normal People

As jobs disappear and temporary employment becomes more prevalent, reforming our health care system will be more and more crucial. Right now, most of us rely upon our employers to pay for and provide health insurance. This will be increasingly difficult to sustain as jobs with benefits become harder and harder to come by. On the consumer side, spiraling health care costs have already become a crushing burden for Americans. Health care bills were the number one cause of personal bankruptcy in 2013 and a study that year found that 56 million Americans – over 20% of the adult population – struggled with health care expenses they couldn’t afford to pay. We’ve all seen and heard the horror stories of people coming back from the hospital with a bill for tens of thousands of dollars. For many Americans it’s a double whammy if you get sick – you not only have to deal with the illness or injury but you have to figure out how to pay for treatment.

In general, the use of technology has not transformed health care the way that optimists would hope. Health care costs have continued to climb to a record 17.8% of the economy in 2016, up from 11.4% in 1989 and less than 6% in 1960. We spend about twice what other industrialized countries do on health care per capita to lesser results. According to a 2014 Commonwealth Fund report, we are last among major industrialized nations in efficiency, equity and health outcomes attributable to medical care despite spending much more than anyone else. Another study had the U.S. last among developed countries in basic measurements like the rate of women dying due to pregnancy or childbirth and rate of survival to age 5. To the extent that new technology is used, it tends to be expensive new devices and implants that drive costs ever higher. The basic practice of medicine, as well as the training, is the same as it’s been for decades.

Our job-based health insurance system does the very thing we most want to avoid – it discourages businesses from hiring. For employers, company-subsidized health insurance costs are a major impediment to hiring and growth. The costs get very high for senior people with families – my last company was spending more than $2,500 a month on certain people’s insurance plans. If these costs weren’t on our books we definitely would have hired more people. Health insurance also pushes companies to make as many employees as possible into part-time gig workers or contractors.

On the worker side, tons of people hang on to jobs that they do not want to be in just for the health insurance. Economists refer to this as “job lock;” it makes the labor market much less dynamic, which is bad in particular for young workers.

As jobs disappear, having one’s health care linked to employment will become increasingly untenable. The need for a different approach is growing.

Health care is not truly subject to market dynamics for a host of reasons. In a normal marketplace, companies compete for your business by presenting different value propositions and you make an informed choice. With health care, you typically only have a few options. You have no idea what the real differences are between different providers and doctors. Costs are high and extremely unpredictable, making it hard to budget for them. The complexity leaves many Americans overwhelmed and highly suggestible to experts or institutions. When you actually do get sick or injured, you become cost-insensitive trying to get well. Hospitals often employ opaque pricing, resulting in patient uncertainty over what their insurance will actually cover. Moreover, when you’re ill, it’s possible your faculties can be impaired because of illness, emotional distress or even unconsciousness.

As Steven Brill wrote in his seminal Time magazine article on health care costs, “Unless you are protected by Medicare, the health care market is not a market at all. It’s a crapshoot.” The lack of real market discipline or cost control incentives has driven costs ever higher. Technology that should decrease costs has been kept at the door because for most actors in the system, the goal is to increase revenue and profitability. The more services, tests, appointments, procedures and expensive gadgets you use, the better. The system rewards activity and output over health improvements and outcomes.

Changing these incentives is key.

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