The Problem: The US spends twice as much on healthcare as other developed countries – about $5000 more per capita per year, on average. The US spends 18% of GDP on healthcare, compared to an average of about 11% in other developed countries. Yet 10% of Americans have no health insurance while most other developed countries have universal coverage.
The Mission: figure out how to achieve universal healthcare coverage in the US while slashing costs but without compromising patient care.
The Method: Identify problem areas. Figure out why they're problem areas. Come up with fixes. Throughout the process, compare the US healthcare system to cheaper systems elsewhere to figure out what went wrong and how we can make it better.
Explorations So Far: Twenty-seven posts and counting
A Few Recommendations*:
- Stay with a multi-payer system for now; Americans like choice and multi-payer systems don’t need to be pricey, as Japan and Germany have shown
- Implement a strictly enforced country-wide fee schedule for medical services, allowing for local cost-of-living adjustments. This would reduce the cost of administration as well as patient care, e.g., less time haggling over bills.
- Increase federal and state government budgets for the detection and prosecution of fraudulent medical billing, such as upcoding.
- Greatly expand the number of nurse practitioners working as "full practice" primary care providers and gatekeepers, a status that allows them to work independently of a physician's clinical oversight. This will require changing the law in some states and increasing the number of training programs.
- Institute a no-fault medical malpractice system, much like the very successful one in Denmark. This will decrease defensive medicine while improving patient safety.
- Develop comprehensive federal guidelines on diagnostic procedures and treatments, much like they have in Britain. Medical providers and insurers would consult the guidelines to ensure cost-effective appropriate care.
Well, it's a beginning.
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*
You’ll notice that there are no recommendations for making drugs cheaper in the US. That’s because our per capita drug costs aren’t all that much higher than that of other developed countries when you consider overall healthcare spending. Sure stuff could be done (e.g., increase power of government entities to negotiate lower drug prices; reform clinical trials system), but savings would only amount to a few hundred dollars a year per capita. See the third post in this series for more details.
References:
Bradley Sawyer and Cynthia Cox How does health spending in the U.S. compare to other countries? Kaiser Family Foundation. February 13, 2018
Papanicolas I, Woskie LR, Jha AK. Health Care Spending in the United States and Other High-Income Countries. JAMA. 2018;319(10):1024–1039. doi:10.1001/jama.2018.1150