One reason US health care is the world’s most expensive is the wasteful policy of using highly trained people to do tasks that could have, and were once done, by people with considerably less training. There is little if any evidence that this policy does anything worthwhile except increase costs. For example, hospitals used to train their own nurses. This had two benefits: One, it cost less. And second, the training was more specific to the task needed. There is also the concept of “task specific” training which was extremely common during World War 2 when there was no time to waste in unnecessary training. Winning the war and defeating the enemy was far more important than teaching things found to be unnecessary when it came to bringing in untrained people to do tasks that previously were done by people now in uniform and fighting the “enemy”. As a matter of fact when my wife started working in the local hospital, they trained people using task specific training to do tasks that now require an associate degree to do. This is also the problem today where no one is willing to “train” people, but now expect the educational system to do it. I believe our “out of control” legal profession may be to blame here…
Our health care system has greatly excessive health care costs due to the administrative overhead costs of running our health care system. In effect we “waste” somewhere in the neighborhood of half a trillion dollars at least. I consider this figure “low”, but I will use it. When the UK can cover everyone as they did in 2015 for 7.7% of their GDP, while at same time Germany spent 9.8%, and the US spent 18%, you know something is seriously wrong! Nor has Obamacare (or whatever the Republicans can dream up) done anything about this. The average hospital has as many “paper shufflers” as it has patients under care. Hospitals in the rest of the developed world use far less. They also use appropriately trained people to do the patient care needed. They are “efficient” in producing the greatest value at the lowest cost. We do the opposite. While I will grant that countries like the UK don’t offer the latest “cutting edge” care, they do manage to deal quite well with the very little that they spend. Where here in the US, the cost of health care is effectively bankrupting the country with its heavy drain on our economic resources. It has been estimated that by 2024, US health care will consume 25% of our GDP! Or about $5,000,000,000,000 (five trillion) dollars a year. We seriously need to start considering what we can do to bring these costs down to more reasonable levels!
The concept of a Basic Income plan is rather well known today. However we also need to create some sort of basic health care plan so that there would be universal access to a basic level of health care. This plan would have deductibles based upon income, and would give everyone access to generic medications (no prescription laws) and would use people trained in basic health care (nurse practitioners). This would be a very “basic” plan, and those who wished to have a higher level of care would be able to purchase such through the private health insurance system out of their own pockets. Similar in principle to the Medicare Advantage plans that now exist. However there would be no requirements as exists with Obamacare to offer “infinity coverage”. No one buys “no limits” insurance for anything else! There is no reason why we should be doing it in health care. Even Medicare does “limit” coverage. There are sizable deductibles, and the hospital Part A has a limit on coverage. After which you are “on your own” or more likely “on Medicaid”. Generally if someone does reach this point, they are likely to die anyway. Realistically, all Obamacare created was a means to force people to buy very expensive insurance few would ever use. This is why we need to create something that provides some level of coverage for everyone, but is still “affordable” in the sense that it will be something people can buy into… Financing probably should be by the most economically efficient means possible. This requires additional study but lowering US health care costs to something more like what the rest of the developed world pays does seem to be “doable” given different leadership than what we’re got now. The idea is to do what is economically possible without bankrupting the country which is the course we seem to be now heading. Something around 10% of GDP. Germany does it, and their health care system is pretty good and close to comparable with our own.
The plan would provide for public health clinics which are the most effective means of providing basic health services to the maximum number of people at the lowest cost. In effect we’d have the sort of health clinics that existed half a century ago. A means to bring basic health care to everyone, especially those whose incomes are too low or have pre-existing medical issues that make the purchase of health insurance prohibitively expensive. These clinics could also replace immediate care centers and considerably reduce the number of people going to hospital emergency rooms. By using medical practitioners with bachelor degree level of training along with access to an “electronic” doctor (doable at our present level of technology) costs can be held down to a minimum level. This is quite sufficient to deal with “chronic medical issues” such as high blood pressure, high cholesterol, arthritis, and high blood sugar (diabetes). Also sufficient for various issues of the type that were dealt with half a century ago. Like broken bones, injuries from falls, cuts, the sort of things that can be handled by people with a basic level of training in health care. Reserving the more educated MD level medical providers to issues that actually do actually require that level of knowledge. The idea is to reduce the cost of US health care by bringing into play a level of medical services that are adequate to do with “every day” types of medical issues. These type of clinics did exist back in the 1960’s and were used by sponsoring hospitals to reduce the numbers of people without health insurance flooding into the emergency rooms where the cost was far greater for treating simple issues. Especially those who didn’t have the money to pay for regular doctor visits. Which while costs much less than doctors today, there were still a lot of people who couldn’t afford the higher cost of a doctor office visit.
Any hospital coverage should be designed to cut costs as far as possible. Large wards are the best way to hold down costs and reduce the cost of nursing care at the same time. This was BTW the way we used to do it. And the nurses were only trained to the level actually needed. RN’s supervised LPN’s who in turn watched over the aids doing most of the “shit work”. There were also student nurses who “learned on the job” how to do things. Task specific training was the standard of the time. This is why the costs back then were as low as they were. Why health care was actually “affordable” back then when few people had health insurance. Because the “money” wasn’t there to waste on stuff that most people didn’t need, the cost of running a hospital wasn’t that high. Think “skilled care nursing home” and you’dd have a pretty good idea of what an early 20th Century hospital looked like.
US health care costs back then were in the 5% of GDP. People mostly paid “out of pocket” for care. Some people belonged to organizations that would pay a doctor to provide services for its members. The AMA opposed this because doctors were forced to compete with each other for these services. The AMA has always been in opposition to a free market in health care. Again we see how the professions force up costs for their own benefit. But once libertarians start showing people how we can have “affordable” health care (like the rest of the developed world does), then perhaps we can get these costs down to more reasonable levels.