A Single-Payer Healthcare System for All Americans

KISS - Keep It Simple, Stupid

K.I.S.S. – Keep It Simple, Stupid. (I got this cartoon on Facebook and decided to share.)

For most of us, getting healthcare in this country is way too hard, as the video at the end shows. So to those in Congress who would make it even harder, I say, “Keep It Simple, Stupid,” with a single-payer healthcare system for All Americans.

WHERE’S THE VISION?

I responded to an article in The Guardian that critiques Democrats’ healthcare arguments, and another article in The New York Times that criticizes Republicans. The NY Times article describes a structural flaw in modern capitalism, where tremendous income gains have gone to those at the very top while prospects have diminished for those in the middle or bottom.

Both polarized political parties seem to lack a clear vision for America, and without a strong vision, Republicans have been separating themselves from traditional conservative policy. Even the term “compassionate conservatism” has vanished. I voted for Bush, but without compassion and goals I can believe in, I can no longer call myself a Republican.

Because I’m a consumer advocate, I must oppose policies that seem to be, “for us to win, you must lose.” That selfish meanness is why I now call myself a Progressive. It’s why I founded Modern Health Talk five years ago, why I voted for Obama, why I supported the Affordable Care Act (ACA), and why I still advocate long-term for a single-payer universal healthcare system like Medicare-for-All. It’s also why I endorse a public option as a path toward that objective.

Unlike modern Republicans (and many Democrats), I have a vision for America where government and individual citizens cooperate in a functioning society and share responsibility and benefits. We must collectively invest in public education, public safety, public infrastructure, public utilities, and a skilled, healthy and productive workforce to drive innovation, profit, and GDP. You see, I value capitalism like Republicans, but I also know the benefit of public-sector organizations and initiatives. And I know that no individual or company “makes it” on their own. With that in mind, one of my first articles here described a hybrid public/private healthcare system that blends the best of socialism and capitalism.

MY ADVICE FOR DEMOCRATS

I like most of the populist message of Bernie Sanders and Elizabeth Warren, but I worry that they both are too far to the left and may scare away moderates. I’m not sure they share my vision for America, because their rhetoric seems to blame wealthy corporations and individuals, and capitalism, and their plans seem intent on punishing with high taxes and strong regulation.

Sure, Progressive policies and tax reforms are needed, but the Democrat’s message needs to be simpler, gentler and more inclusive. Make the case that we as a nation must share both the responsibility and benefits, and invest strategically – i.e. work together.

As for healthcare, quit complaining about Republican efforts to repeal & replace Obamacare, because that’s what they campaigned on, and your arguments are landing on deaf ears. And quit trying to save Obamacare as it stands, because it does have flaws, and Republicans know how to break it. Take the high road and the initiative by reaching across the aisle with a better plan – a plan that has broader objectives that both sides can support, like saving over $1.5 trillion each and every year in overall healthcare costs, while also improving outcomes and developing that skilled, healthy, and productive workforce.

MY ADVICE FOR REPUBLICANS

Republicans had 7 years to step back, ask the right questions, and then work with Democrats and all stakeholders to craft a workable Obamacare replacement. It doesn’t take a rocket scientist to know that Medicare-for-All would satisfy campaign promises to replace Obamacare with a system that provides everyone with care that’s better and cheaper. I find it ironic that Republicans still claim to be the party of fiscal responsibility but failed so poorly to see the potential savings of universal healthcare. There’s still time to change course, knowing that 80% of the nation doesn’t want their hastily and secretly devised plan.

MEDICARE-FOR-ALL

As the latest Republican attempt to repeal Obamacare stalls in the Senate, Democrats like Robert Reich argue that basic healthcare should be a right and guaranteed for all Americans.

OUR HEALTHCARE SAVINGS POTENTIAL IS IMMENSE

The U.S. now spends over $3.3 trillion/year on healthcare – in total, including insurance premiums, deductibles, out-of-pocket expenses, and government subsidies. That’s more than 17% of GDP, and it’s going up with 11,000 people turning age 65 every day and needing more care in old age.

The big savings potential is because our total spending is twice as much as what the other advanced nations pay, yet we still live sicker and die younger. Those other nations also struggle to constrain rising costs, but they have simpler and more-efficient single-payer systems that make coping with aging populations easier. Their incentives better align with goals.

To reach the savings potential, politicians must go beyond universal healthcare, because Medicare-for-All is not enough. It’s just another way of paying for health care. Although it’s far more efficient than any private health insurance, it doesn’t reduce the need for care in the first place. For that we need to focus on health, wellness and prevention, because as Benjamin Franklin said 250 years ago, “An ounce of prevention is worth a pound of cure.”

TECH INNOVATION WILL IMPROVE CARE DELIVERY

Moore’s Law and the FUTURE of Health Care” is an article I wrote from the perspective of a retired IBM technologist and futurist. It looks at the convergence of information science (processors & networks), biology (chemistry, genes & proteins), cognitive & neuroscience (neuron signaling), and nano technology.

SPECIAL INTEREST LOBBYING WILL SLOW PROGRESS

While I’m guardedly optimistic that tech innovation will greatly improve care delivery, I worry about misaligned incentives that promote profit from disease management rather than health & wellness, and about special interest lobbying. In his TIME Magazine report, “Bitter Pill: Why High Medical Bills Are Killing Us,” Stephen Brill describes the Medical Industrial Complex, which spends 3-times as much on lobbying as the military industrial complex. They obviously don’t want to lose $1.5 trillion/year in revenue and will oppose any of the reforms I suggest. Unfortunately, Brill’s article is now behind a subscriber pay-wall, but I posted a summary and a video interview with the author.

IF AIR TRAVEL WORKED LIKE HEALTH CARE

This satirical video makes fun of our overly complex healthcare industry, looking at what the airline industry might be like if it worked the same way.

Let’s Change the way we see Health Care

Rather than a Wall, America needs to build a Giant Mirror to reflect on what we've become.

Rather than argue over who pays for what and who gets health insurance or access to care, and who doesn’t, maybe we need to step back and ask different questions, starting with…

“Is basic health care a human right, or is it an earned privilege?”

And if people can’t afford it, does that mean they aren’t working hard enough, aren’t determined enough, or are just Losers and don’t deserve it? Read More …

When Caregiver Robots Come for Grandma

Failing the Third Machine Age: When [Caregiver] Robots Come for GrandmaWhen Robots Come for Grandma is a long and thought-provoking article by Zeynep Tufekci, published in 2014. It builds a case against “caregiver robots,” arguing that they are both inhumane and economically destructive. She got me thinking, and I hope this has the same effect on you.

I would have liked to add my own perspectives and contrarian view with links to related articles here at Modern Health Talk. I’d start with Will Robots Take Over in Health Care? Unfortunately there was no space to add comments, so I use her article as a basis for mine and hope you’ll share your thoughts in the space I give below. Read More …

People Like the ACA, so it’s hard to Repeal. Here’s why.

It’s not surprising that so many people like the ACA (Affordable Care Act), and that it’s been difficult for Republicans to repeal.

ACA (Obamacare) versus AHCA

Here are 12 reasons people like the ACA (also known as Obamacare), along with detail in supporting charts that compare it with the Republican’s American Health Care Act (AHCA). Most of this work is attributed to The Century Foundation.

1.  The uninsured rate across all ages and income levels has fallen to the lowest level on record, thanks to the ACA’s health insurance exchanges, Medicaid expansion, and other provisions.

Read More …

Ask the Right Questions about Healthcare

Politicians Need to Ask the Right Questions about Healthcare (Photo credit: SupremePatriot.com)

By Wayne Caswell, Founder of Modern Health Talk

Politicians Need to Ask the Right Questions about Healthcare

In Healthcare: Mandatory Coverage or Universal Access?, Dr. Josh Luke presents one perspective – that of a hospital CEO. Readers should know that he represents the medical industrial complex, which also includes insurers, drug companies, equipment providers, and testing companies. Their collective interest is to protect the perverse profits that come from illness and injury, and the fee-for-service incentives that encourage ongoing treatment of symptoms. I found Dr. Lukes’ framing of the healthcare issue too partisan, so I had to respond. My responses form the basis of today’s posting.

What’s the DIFFERENCE between Universal Healthcare and Universal Access? Republican politicians have promoted Universal Access, confusing it with Universal Healthcare. Access, however, only means you can get health care if you can afford it. That’s like having the ability to buy a luxury yacht or summer home, but only if you have enough money to afford it. Progressives instead want Universal Healthcare, a concept I endorse here at Modern Health Talk. It’s efficient and what other advanced nations have. So let’s reframe the issue by asking different questions.  Read More …

American Health Care Act, a Summary & UPDATE

 

By Wayne Caswell, founding editor

UPDATE 3/24/2017 — Not enough Republicans agreed to pass the American Health Care Act, which would repeal much of Obamacare and kill thousands of Americans by leaving them without health care, so they pulled it.

UPDATE 3/24/2017 — Republicans in the U.S. House of Representatives scheduled a critical vote today but could not secure enough votes within their own party to pass the American Health Care Act. So Speaker Paul Ryan and and President Trump decided to pulled it. The bill to partially repeal Obamacare would partially fulfill a campaign promise and give tax breaks to wealthy benefactors, but it would also steal from the Medicare Trust Fund, gut Medicaid, and result in the deaths of Americans by leaving them without health care. Pulling the bill was a better option than facing angry constituents, 85% of whom were against it. Read More …

Healthcare as Public Utility

healthcare as a public utility - image of health care practitioner with handheld mobile deviceComputing functions once associated with PCs are moving back to big servers in the Internet Cloud, leaving mobile client devices to handle the user interface (UI) but not the data storage and analysis. I find this shift especially interesting, having grown up in the mainframe world at IBM as computing functions moved to PCs.

In the case of speech recognition and Apple’s SIRI artificial intelligence, even the UI function is now split between client & server. This has huge implications for healthcare, with IBM’s Watson and AT&T’s analytics engine aimed at different parts of the healthcare problem.

The networked mobile device (phone, tablet, etc.) will serve as a health gateway between a host of medical & environmental sensors and cloud-based services that collect & analyze the collected data. The benefits will not just target individual patients but be applied across large populations.

Read More …

Why Republicans Want to Repeal Obamacare

Robert Reich on Why Republicans want to Repeal Obamacare

Here’s what Reich says about an Obamacare repeal:

  • 32 million people will lose coverage, [UPDATE: 24M per Congressional Budget Office]
  • Tens of thousands of American’s will die as a result,
  • Medicare and Medicaid will be left in worse shape, and
  • The rich will get richer in a massive redistribution of wealth.

Missing from this list, and discussed after the video, is how Republicans can use the repeal to maintain control of Congress, the Presidency and the Supreme Court, even as a demographics shift works against them. Read More …

Influencing Healthcare Policy – Lobbying, Incentives & Insurance

Benjamin Franklin is credited as saying, "An ounce of prevention is worth a pound of cure," but policymakers seem more influenced by the money he's pictured on.

Ben Franklin said, “An ounce of prevention is worth a pound of cure,” but policymakers seem more influenced by the money he’s pictured on.

By Wayne Caswell, Founding Editor, Modern Health Talk

As President Trump’s administration transitions from the Obama era, a conservative ideological shift will influence healthcare policy, but so will other factors. They are discussed here, based on my response to “The Past, Present and Future of Healthcare Policy” at ReferralMD.

Influencing Healthcare Policy

Although The Patient Protection and Affordable Care Act, more commonly known as ObamaCare, has flattened the curve to the lowest annual cost increase in decades, it still has not reduced overall costs for many reasons. These include (1) special interest lobbying to protect industry revenues & profit, (2) misaligned incentives, and (3) an insurance middleman that adds more cost than value. It is unlikely that any “repeal and replace” strategy can live up to Trump’s promises because of these three factors. Read More …

US Healthcare System has Cancer. Can Trump Fix it?

By Wayne Caswell, founding editor, Modern Health Talk

Dr. Sudip Bose says, "The epicenter of health care is the doctor-patient relationship."

Opening his January 16, 2017 Huffington Post article, Dr. Sudip Bose said, “One thing is certain about the future of Obamacare, and that is that it will change under a Donald Trump presidency.“ Given his public statements, Trump will clearly make sweeping changes sooner than later, but what those changes will be is anything but clear. That’s why today’s article describes what I hope for, if not what I expect.

The US healthcare system has cancer – a malignant form that started way before Obama became President, and it has taken decades to grow to its current condition, where our very existence is threatened. It’s my hope (remember Hope & Change?) that healthcare reform under Trump will not just treat the symptoms of a growing healthcare cancer, like the lack of insurance competition or price transparency. I hope Trump will recognize the need to treat our healthcare system’s cancer aggressively, naturally and holistically. Will he? Read More …

Universal Healthcare Opposition

Obamacare Protest Sign shows Universal Healthcare OppositionWhat is REALLY behind universal healthcare opposition? It’s the fear of helping “LOSERS”

I felt compelled to comment on this article in MedCity News. The article said FEAR was a dominant reason some Americans find it so hard to support the kind of universal healthcare that all other advanced nations have. The dark side of this belief is that “Nobody wants to pay for FREE healthcare for anyone who doesn’t work hard enough, doesn’t have enough determination, or is a Loser” and doesn’t deserve it. The US stands out in this regard, since we are the ONLY one among the 33 advanced nations that does not provide universal healthcare.

While these other countries see healthcare as a basic right and thus a social responsibility, in the U.S. it doesn’t seem to matter whether these ‘losers’ are old people or little kids, are people who lost their jobs, are people with serious health problems through no fault of their own, or are people bankrupt by a serious injury. Those who are afraid to help ‘losers’ speak of defunding the government or killing Obamacare, with no apparent concern that the OECD reports that 17% of US households live below the poverty line, or that they can’t afford healthcare and have an average lifespan 20 years less than those in affluent neighborhoods on opposite sides of the same town.  Read More …

Corporate Behavior and Rising Health Care Costs

As the dust settled from the Supreme Court ruling on the Affordable Care Act (aka Obamacare), one of my LinkedIn groups got into a debate about what it all means and what needs to happen next. I got such a positive reaction from one of my comments that I thought I’d share it here, followed by details of the documentary I mentioned.

My Comment

The aging population adds significantly to healthcare costs, but that’s a global problem and not specific to the US, so what is it about our nation that makes our healthcare system the most expensive in the world by far and without the positive outcomes to justify it?

As a consumer advocate, I believe our problems are rooted in our politics and societal beliefs and find it quite telling that, according to the HBO documentary “The Weight of the Nation,” public health officials can accurately gauge one’s average weight and BMI by zip code. It’s also telling that longevity in poor neighborhoods can be over 20 YEARS LESS than in affluent neighborhoods on the other side of the same town. Watch the video and see the stats at http://www.mhealthtalk.com/2012/06/americas-obesity-epidemic-a-big-problem-updated/.

I especially feel for children born into poor families or the “new poor” that were once middle-class families, but where the parents lost their job and/or home at no fault of their own, got hit with a health emergency, and have since burned through any retirement and capital investments they once had. Poor families often have:

  • Less access to healthcare, even from pre-birth,
  • Less access to affordable and nutritious foods,
  • Less exercise opportunity, with fewer places to safely play,
  • Inferior public schools (college seems out-of-reach),
  • Fewer job opportunities, and
  • Less say in government.

Read More …

Envisioning the Future of Health Care

Envisioning the Future of Health Care

At the end of each New Year, it seems everyone has a list of top trends, as Dr. Meskó did in The Most Exciting Medical Technologies of 2017.

MORE PREDICTIONS: I too have made predictions (http://www.mhealthtalk.com/101-minitrends-in-health-care/) and often point to the hidden opportunities that lurk at the intersections of MiniTrends. Most futurists miss those if they just extrapolate obvious trends without factoring in the many market accelerators and obstacles that determine how quickly a preferred version of the future appears. Read More …

Disrupting Healthcare with Functional Medicine 2.0

Disrupting Healthcare with Functional Medicine 2.0

By Dr. Shaiv Kapadia, Chief Medical Officer and Co-Founder, Iggbo

The United States has the best and worst healthcare system in the world. Let me explain. If you are having a heart attack or stroke or a victim of an accident, there is no better integrated system of acute care delivery on the planet. Chronic disease, however, is a completely different story. [EDITOR: The medical industrial complex spends twice as much on political lobbying as the military industrial complex, to avoid disrupting healthcare as they know it. That’s because cutting costs to match what other advanced nations pay per capita would mean losing over $1.5 trillion/year in profits – profits that today mostly come from treating symptoms.] Read More …

Medical Marijuana Lowers Prescription Drug Abuse

Medical Marijuana Lowers Prescription Drug Abuse

Research Shows That Medical Marijuana Lowers Prescription Drug Abuse

Guest article by Helen Smith

The abuse of prescription opioids such as heroin, morphine and prescription painkillers is a global problem affecting up to 36 million people worldwide. Opioid addiction is of particular concern in the United States, with over two million people abusing prescription medications and around half a million addicted to heroin. The consequences of opioid abuse are immense; the Centers for Disease Control (CDCP) and Prevention notes that deaths via the overdose of prescription medications have risen four-fould since 1999; almost half of all opioid overdose deaths involve prescription medications. The most common medications which contribute to so many needless deaths, are methadone, oxycodone and hydrocodone. The CDC notes that around 1,000 people are treated daily in emergency rooms following the abuse of prescription drugs.

There may be a light at the end of the tunnel, though, with research showing that medical marijuana may curb the rate of prescription drug abuse. Read More …

The Big Heist – Become a Benefactor

The Big Heist, a satyrical documentary about our broken healthcare systemYou can be part of History by becoming a benefactor of The Big Heist, at any amount. This documentary-in-process is a satirical, follow-the-money film about healthcare, the status quo, and efforts to fix our broken system from the ground up.

The Big Heist blends the comedy & parody styles of ZDoggMD and The Daily Show — to entertain and educate with the goal of transforming the public’s understanding of our nation’s healthcare system, along with the causes of its dysfunction, and how to truly fix it. This has been my personal passion since founding Modern Health Talk five years ago. I’ve already published over 100 articles on different aspects of healthcare reform public polity, sharing my own technical & futurist perspective and insights, and I love hearing other viewpoints with similar aims. Read More …

Benefits and Risks of Artificial Intelligence

This image represents Artificial Intelligence, a digital mind that can learn and act on its own. According to a recent article in MedicalFuturist.com, artificial intelligence (AI) will redesign health care with unimaginable potential. The author sees great benefits, and so do I, but he dispels the risks – risks that visionaries like Bill Gates, Elon Musk, and Stephen Hawking warn against. They warn that full development of AI could spell the end of the human race, and I share that concern. That’s why I’m writing today’s article with a cautionary tone.

The accelerating pace of change

At issue is whether or not man will find ways to guard against the dangers of tech innovation accelerating exponentially and indefinitely. The questions start with, what will AI, automation and robotics eventually do to employment? Which jobs will be replaced first, and which are safe for now? What might AI do for (or to) government? I don’t share the author’s confidence and instead side with the visionaries. Here’s why. Read More …

Are Crypto-Currencies Safe?

Here's a Bitcoin - at least a representation of one since they're actually electronic

Here’s a Bitcoin – at least a representation of one since they’re actually electronic

Last week Yvonne and I closed on the sale of our Austin home and the purchase of another home in the Dallas area. The process was simpler than I remember from the past, and since we paid cash for the new home, we didn’t even need a notary. I just downloaded a few forms, signed them on the kitchen table, scanned into the computer, and sent them back to the Title Company through a secure email service. This experience foretells the future, but are crypto-currencies safe? Really safe?

The US Department of Health and Human Services (HHS) is soliciting research papers related to blockchain applications in healthcare. Blockchain is the enabling technology behind BitCoin and other crypto-currencies, and it’s catching on fast — maybe too fast. Judge for yourself. Read More …