(As Transcribe From Mini-Med Minutes Podcast)

 

Welcome back everybody to another episode of Mini-Med Minutes.

 

And today we’re going to be continuing our discussion about Universal Healthcare.

 

We’ve already talked about how awesome it is. How not awesome it is. What the US Healthcare System looks like now, and we’ve also looked into some very different versions of universal healthcare overseas.

 

Today we’re going to be talking about why we don’t have it here in the US.

 

Former President Trump has been elected into office as of a few hours ago upon recording this so unfortunately it’s unlikely that we’ll have any improvements in our healthcare system for a very long time.

 

None the less, politics aside, there are other reasons we may not have a national healthcare system.

 

And the obvious starting place for the discussion is… do we even want it.

 

In general, are more people on board or against it?

 

Statistically speaking, there are more people for a Universal Healthcare system than against.

 

The Kaiser Family Foundation conducted a poll in 2022 which found that 65% of Americans support establishing a national health plan, which would provide coverage to everyone, including 79% of Democrats, 61% of independents, and 51% of Republicans

 

They also conducted a poll in 2023 finding about 68% of Americans are worried about the cost of healthcare and the ability to pay for it.

 

And then among the younger folks.

 

Harvard conducted a poll in 2023 which showed that 86% of respondents aged 18-29 favor a national health plan, illustrating a generational shift towards supporting universal healthcare.

 

Though I will say that an 18-29 year old will havre less of an understanding of what Universal Healthcare is which is why we’re talking about it now…

 

But none the less, the support is there.

 

So what’s really stopping us?

 

I’ve compiled a list of 7 Reasons.

 

Buckle up.

 

1. Political Divisions: The U.S. political landscape is highly polarized. We just don’t see eye to eye. We have significant divisions between parties on healthcare reform. While a lot of Democrats advocate for universal healthcare options, Republicans often express concerns about government involvement in healthcare and potential increases in taxes. This makes it very hard to pass reforms, even when public support exists. 
2. Powerful Interest Groups: The healthcare industry in the U.S. includes powerful lobbyists from pharmaceutical companies, insurance providers, and medical associations.

 

I couldn’t tell you for certain, but I think this is the most significant reason why an overhaul in our healthcare system has happened yet.

 

You could imagine the devastating impact this can have on several, very large businesses. I’m not sure what insurance companies would do if we make that change. They could likely be absorbed and help process health insurance claims for the system we put in place so there’s not a devastating loss in jobs.

Or they could offer supplemental insurances for services the federal government doesn’t cover enough of.

And then there’s PBMs, who are the middlemen who negotiate prices between insurances, manufacturers, etc. I wouldn’t really see a place for this service anymore. They could continue doing what they’re doing for the supplemental insurances but that market would be so small there would ultimately be no point.

Manufacturers lose the ability to negotiate prices with several competing businesses and are forced to do business and negotiate with primarily or solely the federal government which would ultimately reduce their profits.

And then there’s the providers. Reimbursement rates could change for drugs and services which could affect profits for doctors and pharmacies.

But the increase demand in services would ultimately lead to higher volume of care.

It looks to me that it would create a butterfly effect and we would have to monitor it closely.

It’s very difficult for companies to make changes like this because they would essentially lose a lot of control over the profits of their business.

 

 

• Fear of Change: Many Americans have concerns about transitioning to a universal healthcare system, including fears of losing their current insurance, potential long wait times for services, and reduced quality of care. This anxiety can lead to resistance to change, as people are often wary of altering a system they are accustomed to, even if it may ultimately benefit them in the long run.
   

  I’ve talked to a lot of young healthy people about this topic specifically and they’ll often say things like, “it’s obviously better, why wouldn’t we want to do this.”
  
  
  And if you’re dependent on certain medications or medical services, it’s scary. Even changing from insurance to insurance causes massive problems sometimes so changing an entire healthcare system is obviously daunting.
  
  
  Imaging requiring a biologic medication like Humira and then suddenly requiring to jump through several hoops to now get it… delaying your care for days to weeks to months. It definitely happens with our current system already.
  
  
  And that leads us to #4. 

 

 

• Existing Infrastructure: The U.S. already has an extensive healthcare infrastructure with established private insurance systems and providers. Transitioning to a universal healthcare model would require gigantic changes to this infrastructure, which could lead to disruptions in care and concerns about how to integrate existing systems into a new framework.
   

  If we do it, it will be a mess at the start and a lot of people are going to say wow, we should never have done it, without giving it the time to mature. On the other hand, it could actually really end up being a mess depending on how it’s integrated. 

• Cost Concerns: Although universal healthcare can lead to long-term savings, there are substantial upfront costs associated with implementing a system like that.
   

  People against it often highlight the potential for increased taxes or government spending, which can deter support. Even supporters may have differing views on how to fund universal healthcare, creating further divisions on what to do.
   

  With any reform, it’s going to cost money. Making any change to a current system is going to cost money… up front, that doesn’t mean we shouldn’t do it, we just have to be smart about it in the sense of, was it worth it.
   

  Everything looks like a mess at the start, we just have to keep trekking forward a little further to know if it was actually a disaster or not, monitor our progress and make little changes along the way. 

• Incremental Change Philosophy: Some policymakers advocate for incremental changes rather than all out sweeping reforms, believing that if we made gradual improvements to the existing system, it will be more feasible and less disruptive.
   

  The problem with this strategy is it really slows down the momentum and the end goal of what it’s trying to do and when we lose sight of the ultimate goal, these small reforms fall short and we start second guessing what the best thing to do is and end up reversing all the progress.
   

  And a lot of people can relate to this. Like you start learning a language, you start learning how to play an instrument. It takes a long time, and you will suck. It is a gradual process. But if you quit, or change instruments, you’ll never get to the end result.
   

  At best, you play several instruments and you’re mediocre at all of them. 

• State Variability: This is a big one. Healthcare right now is handled greatly at the state level and they’re all different depending on healthcare needs, politics, economy… and there’s 50 of us to consider. This makes it challenging to make a one-size-fits-all solution for universal healthcare, complicating the potential for nationwide reforms. 

 

So… can we do it?

 

Yeah we can do it. Other countries have done it.

 

I think what stops us the most is politics and money.

 

If we were to implement a Universal Healthcare System.  I think it’s going to look like the following:

 

We’re going to choose a model of course. Medicare-for-All, or a multi-payer model like Germany or a mixed model like Canada.

 

And we’re going to roll it out as a pilot in certain communities to demonstrate its effectiveness.

 

Patient care outcomes are going to be the obvious top factor in regards to this.

 

I think implementing it is going to be trivial in that regard.

 

What we should also look at is the economic consequences or positives that come about with the change.

 

If we alleviate some administrative burdens like billing complex insurance plans, how much time does it save, how much more efficient do other tasks become. Where are we putting that extra work?

 

If we reduce the complexity of the healthcare billing systems by reducing the corporate handle on it, I could definitely see the possibility of shrinking office staff, meaning less jobs. Less personnel would be required to handle what was previously a complicated process and required extensive man power to manage.

 

For instance, Pharmacy Benefits Managers or PBMs are the middlemen between insurance companies, drug manufacturers, and pharmacies. 

 

Their job is to manage prescription drug benefits for health insurance plans. They negotiate drug prices, decide which medications are covered, and work to get discounts from drug companies. 

 

In short, they try to lower drug costs for insurance companies and sometimes for patients—but they also make money from these deals too.

 

If we have a Universal Healthcare system where the government is handling those negotiations, I’d have trouble finding a place for a PBM in that system.

 

If you don’t know what this means, I’ll give you an example of what that looks like now that I gave previously.

 

You see your doctor and he diagnoses you with, let’s say diabetes. He would like for you to start therapy with some medicine. He likes a drug called Jardiance, he sends the pharmacy a prescription for Jardiance.

 

Now we’re at the pharmacy, pharmacy bills the insurance for the Jardiance. Insurance says no, either they don’t like the dose the doctor wants the patient to take, or they have a deal with another manufacturer to use their drug instead.

 

Basically, insurance says no. If they’re nice enough, they’ll tell you what they do cover… and then the pharmacy can spend the time, to either call the doctor’s office, wait on hold, to talk to reception (not even the doctor) to send them a note, or be transferred, then put on hold again, so doctor can take the time, again, time they don’t have, to draft another prescription to send to the pharmacy.

 

Outside just flat out covering the medicine, that is BEST case scenario.

 

Now imagine if we have a national health system where the provider already knows what medicines are covered. A endocrinologist likely deals with only a handful of drugs on a regular basis anyway and is going to know exactly what it’s going to cost.

 

The complexity is hashed out from the get-go. If they don’t know, it’ll be online on a preferred drug list, just how Medicaid programs have now. And that could be a worse case scenario, having to control+F a spreadsheet for a cost effective medication.

 

So as you might imagine, we might not need a lot of folks in billing and special authorization departments if complexities are reduced.

 

On the other hand, I do think it will actually create more demand (with resources we… might not have, now). And with more demand for health services, we will need more healthcare providers and administrators to support them.

 

So while I do think there will be some shrink in that area, I don’t think it will be incredibly significant because those roles are still important, just potentially not to the degree it currently is. 

 

The amount of jobs it creates I think will ultimately offset it, and then some.

 

Wrapping up

 

So that is my take on the implementation of a Universal Healthcare system and what’s holding us back. 

 

Very controversial, obviously. I know I framed a national health plan in a very positive way because I imagine it to be easier for me, specifically as a provider myself, but I know it has its downsides.

 

If you have an opinion you’d like to share, do reach out. You can find a contact page at PharmacistNutrition.com

 

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Again, thanks for tuning in and I’ll see you next time.

 

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