Medicare/Veterans Administration Health Care for All

I wish to elaborate upon the scope and means of conducting the project described in the posting entitled: "Grassroots Education, Hidden Costs, and Health Care." The scope essentially is that the American health care system is broken and needs to be fixed. The hypothesis is that there are already models in this country (VA (socialized medicine) and Medicare (single payer medicine)) that excel at providing good quality care, appropriate care, and access to care, while keeping overhead/administrative costs in control. The idea is that Americans can get a lot more for current levels of spending, and that the acceleration of costs can be curbed through the expansion of eligibility to the VA or Medicare to any human being living in the US. It follows that, should data support this hypothesis/idea, that a media campaign to educate voters and advocate for legislative change would, if successful, correct a lot of what is wrong in this country.

I can hardly think of a more ambitious project for one's entire lifetime. This can be extended to overhauling the tax code, educational system, and the banking industry in order to create citizens who can think for themselves, demand change from their elected officials, and afford to live in decent housing in decent neighborhoods.

The concept can just as easily be broken down into more manageable chunks. It would be interesting to see what would happen to hospitals and payers should they be reclassified by the IRS as for-profit institutions. What would happen if uncompensated care were to become a fixture of the past; how would health care organizations adapt their schema of community benefits to reach the 5% of total revenues that they are purportedly providing in the current code? How would a community benefit regulatory enforcement mechanism be organized, and what disciplinary powers would it have?

The project might begin elsewhere, examining the amount of money that would be required to provide adequate, appropriate Medicare to all persons in the US. Subsequent research could examine the extent that the federal corporate income tax rate could be increased to reflect corporate savings once the financial burdens associated with providing health benefits to employees were removed. Research could then be done on a parallel increase in federal personal income taxes that would be the equivalent of what is currently being paid in employee contributions to employer-provided benefits premiums, plus what is taken out of taxes for the Medicare Trust Fund, plus the hidden lost wages that have kept current salaries depressed due to escalating health care costs.

Economic projections could then be done on what the cost-curve would look like with the status-quo, Medicare for all, and VA health care for all. The research could continue with an exploration of methods of filling any discrepancies between the latter two curves and total federal dedicated revenues resulting from the corporate and personal income tax increases (with no additional financial burden on either corporations or individuals, at least initially). This might be accomplished by reforming the federal tax code (i.e. eliminating certain deductions), reforming intellectual property and patent law such that pharmaceuticals would enjoy less insulation from competition with generics (hence leading to a drop in prescription drug prices), and by empowering state medical boards and/or other credentialing agencies (e.g. the Joint Commission, with regards to hospitals) to enforce new ethical laws that would require providers to publicly post all financial conflicts of interest with all bodies to which the provider writes referrals (thus checking the unique economic phenomenon of supplier-induced demand, which is sometimes motivated by self-referrals, e.g. by a radiologist to a MRI clinic that he partially owns); the last of these would be designed to essentially reduce over-utilization of diagnostics, tests, and imaging services.

Research could be conducted into the viability of stimulating research and development in the field of medical device re-sterilization and recycling practices (in an attempt to reduce unnecessary institutional medical waste). Research into these and any other primary drivers of health care cost escalation might prove beneficial at identifying potential legislative reforms that would drive cost-savings.

Stake-holder analyses would need to be done to gauge how the potential resultant shift away from private payers, to a lesser extent in the case of Medicare expansion and to a much greater extent in the case of VA care for all, would affect the millions of Americans who are employed in that sector of the economy, or upon whom their business is dependent. Workforce realignment policy options would need to be researched to assess the potential consequences of having the economy absorb this displaced professional population.

In sum, this project would seem to be designed to explore the options and consequences of fundamentally restructuring the health care delivery system in the United States. I do believe that, if done correctly, the data resulting from such research could drive an advocacy campaign that could have the potential for the cultural and political change that would be necessary to grant Americans access to appropriate and affordable modern health care.