SocraticGadfly: Does the US need a full-blown British National Health System (updated)?

March 13, 2017

Does the US need a full-blown British National Health System (updated)?

I've regularly berated Dear Leader for not pursuing single-payer national health care. As part of that, I've regularly mentioned the lack of cost controls in Obamacare, including stating that electronic patient records may have been a neoliberal's techie idea of what might work as cost control, but actually don't, at least not so far. I've also talked about cost controls as an issue in general, such as when Vermont decided to end the idea of a state-level single-payer system.

And now we have a new president, determined to undercut Obama's idea, and with Obama himself having given him the tools to do so. And Democrats defending O-care instead of promising single-payer.

That said, I'm now ready to think that, if we'd had a president with both balls, and convictions, back in 2009 (the only conviction Obama has is for being worse than Bush in the War on Terror, as I see it, along with being worse than Bush in thinking technology + capitalism will solve anything), we should have gone to a "Medicare for All" or other single payer system.

And, beyond.

To exactly what my header says.

A full government-run health care provider system. And, not just one that makes doctors, nurses and other medical staff into government employees, but one that nationalizes for-profit hospitals, which are their own type of vulture, and (since the NFL is a non-profit organization) carefully controls non-profit hospitals.

We need to drop a neutron bomb on the entire current U.S. health care system, raze it to the ground, and make it publicly controlled. (Just like Obama should have taken over banks in 2009, but there you go.)

What's brought me to this point?

A column by Chris Tomlinson noting that within Wall Street's own "1 percent," it's led by two industries: High-tech (no surprise) and health care.

And, this piece showing one health care company CEO getting $100 million, in 1 year. Back in 2009, when Obamacare was being discussed!

And, per my patient records link, not only is it not saving money, it's costing money and the companies who make programs for such record-keeping are making a killing.

And, as of early 2017, a second issue has brought me even further to this point. American hospitals offering spa-type luxury, pseudomedical treatments, or both, are wasting insurer dollars, and would waste taxpayer dollars if we had single-payer national health care without attacking this as well.

We should have had a president with balls and convictions enough to say something like this:

Dear Americans: The only way I can reasonably see to take full control of spiraling health costs, to not only cover all Americans with medical insurance but also to keep that cost from spiraling onward and upward, is to create a true National Health System, like Great Britain has.

Therefore, I am asking Congress to pass complete overhaul legislation where doctors, nurses and other professionals who want to be paid by our Medicare for All program will become government employees. In turn, we will provide generous assistance with medical education tuition, financial stability and speed in cost reimbursement and more.

This is how you force cost control through the whole system.

Doctors and hospitals would have to tell pharmaceutical companies: Sorry, we can't afford anything but generics until you lower your costs. Ditto for makers of medical devices. And, don't boo-hoo that that might cost a lot of American jobs. The pharmaceutical companies have international plants already; ditto for device makers.

Insurance companies like United Health and its $100M CEO could make money only by charging rich individuals cash. But, that would be true under a single-payer system even without the NHS. It's just that an NHS would start at the python's mouth and force the pig of cost control into the whole health care python.

And, if even some Democrats had opposed that, you could have negotiated down to "Just" a single-payer system, with doctors remaining private employees, but with rates and charges under more control than now.

Beyond all the above, Obamacare's been as much clusterfuck as success. And, enough of "Obamacare" has actually had its implementation delayed that we don't even have it, not fully.

Of course, that's another one of Dear Leader's biggest problems — he has consistently negotiated "compromises with himself" in public before ever bringing legislation to Congress. It started with the stimulus bill in 2009.

And, if you think using Twitter as a callout is the modern version of TR's "big stick," that further shows the technie-neolib cluelessness/sellout.

Per the one label on this post, I have long called such stupidity "salvific technologism."

And, we need it more than ever.

Pro Publica has some of the best evidence yet on how doctors and hospitals, just like insurers and Big Pharma (and medical device makers, etc.) rip off the hypercapitalist health care system.


Update, 2017: A basic version would put a government medical clinic in every county in the United States. It would also let national standards trump state ones on what medical professionals could treat what; ie, a lot of it could be done by physician's assistants and nurse practitioners. Texas Comptroller Glenn Hegar shows how bad the doctor shortage is here. At a minimum, a partial NHS, with a government health clinic in every county, is a sine qua non.

We could then combine that with some version of national health insurance. But, having national CARE for basic and preventative services would immediately start the ball rolling on de-capitalizing our current system.

And, THAT is how you do things bottom up. People get used to the government taking care of their kids' vaccines, their own routine physicals and other preventative care, and basic medicine, and they get OK with it. States realize that non-MDs are doing this just fine and accept because they have no other choice.

The US government already runs TWO hospital systems. The VA is not bad, though certainly not perfect. Most its current problems stem from the government not adequately increasing its funding in light of the Iraq and Afghanistan wars.

The other? The Indian Health Service hospital systems have quietly chugged along for decades.

If we had a free clinic in every county in the US, we could then mix and match otherwise.

We might have universal insurance coverage at private hospitals paid by either the government, private insurers or a mix. Many countries with national health care use a two-tier system like that. Government insurance covers all basic medical and surgical needs. You buy private care for elective and experimental surgery and other things.

And thus, per a Vox piece, throwing aside the code phrase of "Medicare for all," I would be OK with a single-payer system with copays and deductibles IF we got the free clinics along with it. Beating for-profit medicine over the head will help make things less expensive than Vox frets.


Update 2, 2017: Tomlinson links to another Chronicle business-section staffer who reports how, here in Texas at least, ER doctors are deliberately ripping off patients with insurance shenanigans and how their hosting hospitals are basically ignoring it. And, yes, Tomlinson himself notes that that's basically what hospitals are doing.

(That also brings to mind a fault with Texas' medical system in general, of how doctors technically aren't employed by the hospitals at which they work. And, I think most other states have similar arrangements.)

Beyond that, insurers do have some fault.

The system as a whole has the biggest fault, though, and doctors, who would benefit more from a universal-payer system, even if not an NHS, still aren't fighting enough for change.


Update 3, May 31, 2019: Arguably, per a longform by Ed Yong on what the next possible plague could do, an NHS would leave us better prepared to fight said plague.


Update 4, June 27, 2019: And, we're now almost at 2020, and while more Democrats say they favor some version of Medicare for All, NONE of them favors making doctors and hospitals take a haircut. And, if you don't, the government goes broke on health care costs, not individuals, but somebody still does go broke. We're not addressing the capitalist camel inside the tent. Kick all of it out, including the nose.


Update, Aug. 12, 2023: Pseudo-socialist Jacobin and PNAP reps talk about a National Health System, but without once mentioning the phrase "fee for service medicine." Nice head fake and I told them that.


Sleeve98 said...

As staff and medical biller of a PCP/General Practice, I've been watching this "spiraling costs of healthcare" issue with increasing frustration.

While Americans are paying more and more in a futile attempt to retain or regain their health, these cost increases impact everywhere except where the rubber meets the road: in the office. Providers have not gotten a decent raise since the Twentieth Century; indeed, what Medicare increases there were, in our fee-for-service system, have been microscopic and cynically scoffable. So if patients are ever more out of pocket, and their doctors aren't seeing an appreciable increase in revenue, to whom is all the money being funnelled away? Go ahead, take your time - it's not hard.

And yet we're surprised that more and more providers reject all but the privately-insured/wealthy cash-pay patients? Where does that leave those kids with Medicaid?

As for the EHRs, you're right, but that's not the full extent. Physicians have been entrapped by HIPAA, forced onto electronic records that I know for fact slow and cripple patient care and treatment. There are a million and one reasons for this, most ostensibly a lack of interoperability, not to mention inserting required computer time between practitioners and the actual, practical treatment of their patients, so until voice interface becomes ubiquitous this will remain a fact (still waiting for Beverly Crusher's medical tricorder).

But as with everything, the devil is in the details. EMR vendors are required by federal law to provide physicians with their patients' data, but nothing in the law says this data must be legible, decipherable or practically useful. This fact, in tandem with current intellectual property laws (like DMCA), allows vendors to keep their EMR's tables proprietary and hold hostage the "keys" to the database for ransom - that is not hyperbole; check out eClinicalWorks, for example. Sure, they'll be glad to hand over the comma-delimited database on a disc, per the law of course. Good luck mapping it to your new software.

This results in literally millions of dollars a year in extortion money, paid to people who have not the first thing to do with sick people or making them better. Payroll and malpractice insurance aside, the software represents the biggest liability a provider faces these days, in many cases outpacing even rent and supplies. And this is why a provider would rather pound a meat thermometer into their ear than change their EHR, regardless of how bad the existing one is, or how much better the new one could be. And I thought Microsoft was good at trapping its customers.

It's not "the cost of health care" that's out of control - it's the array of parasites across the entire industry, requiring and diverting ever more nutrition from the host body, that's responsible. But as you pointed out, instead of relieving some of the pressure, the ACA only emboldened and further empowered the parasites - there is more cancer than there is patient. So when we talk about "controlling the costs of health care," let's call it what it really is: a (so-far vain) attempt to put the insurers, pharmaceuticals, and other vendors back in their box - an excellent argument for Single-payer. Current framing casts a sinister light directly onto the ones who deserve it the least, and we know how easily-confused, and how nuance is so easily lost, on the teabaggers, don't we?

Thanks for the subsidies and new pre-existing provisions, Mr. President, but now it's even harder to find Medicaid patients a freakin' Dermatologist. Things may be getting worse, but it's not the fault of the new law; the parasites have only increased their appetite.

Sorry for the rant, but I've had a belly-full of rhetorical dissembling.

Gadfly said...

One note back to Sleeve. HIPAA need not have any connection to EPR, first. Second, given the way that Silicon Valley and the gummint both want to spy on people, we don't need to weaken HIPAA.