(As Transcribe From Mini-Med Minutes Podcast)

 

Welcome back to MINI-MED MINUTES

 

The presidential election is on its way and healthcare reform is definitely going to be up for discussion.

 

And today we’re going to continue our discussion of Universal Healthcare.

 

If you are elderly or you go to the doctor a lot and you have interest in what a Universal Healthcare can do, tune in.

 

If you are young and healthy and you never go see the doctor. Still tune in because although you may not use our healthcare system often. Your money is going to come out of your paycheck and it may not be just chump change.

 

Also have you ever had something happen to you and because you know how much a doctor’s visit would cost, you simply don’t go.

 

That’s me just about every time when I’m trying to measure costs vs. result.

 

Last episode if you missed it, we talked about how health insurance works and what the US Healthcare System looks like right now.

 

Today we’re going to talk about what it could look like. 

 

What does it mean to have Universal Healthcare?

 

Is everything FREE?!

 

Could be.

 

Or rather it could appear like it.

 

What does it mean to be a Universal Health Care System?

 

But what does it mean to be a Universal Healthcare System?

 

Are we all talking about the same thing when we say Universal Healthcare?

 

Yes and no and it’s kind of profound that the critics of Universal Healthcare are so quick to shoot it down without details, when the details of funding and costs could differ between them.

 

A Universal Healthcare System means that everyone in a country has access to healthcare services, no matter who they are or how much money they have. 

Imagine a country where everyone is automatically covered by a government health plan. 

When someone gets sick or needs to go to the doctor, they don’t need to worry about paying a huge bill because the government is going to help pay for most of the medical costs. 

People may be able to choose which doctor or hospital they want to go to, and they may even have the option to buy extra insurance for more services if they want. 

The key principle is that no matter how much money someone has, they can always get the care they need. They can see a doctor and get treated without worrying about losing all their savings or going into debt.

And I know some people cite our Medicaid programs from state to state which are designed to help people of low-income families. 

 

However, there are obvious holes to it, qualifications can seem unfair, and plan limitations can be a concern.

 

And honestly, it doesn’t solve any of the complex billing problems associated with the entire healthcare system as a whole.

 

What are some examples of Universal Health Care?

 

As we talk about changing to a Universal Healthcare System, it’s important to look at the existing ones out there.

 

There’s tons of them and because of that we have examples, data, and information about how it could work, which one would be good for us, and how successful it might be here.

United Kingdom

Let’s take a look at the UK.

 

The UK’s NHS or the National Health Service is quite famous.

 

It is exclusively publicly funded and was founded on the basis that good healthcare should be available to everyone regardless of wealth and status. And that actually goes for non-citizens as well. I’ve had friends treated for pretty serious health conditions over there at absolutely no charge.

 

And when we say publicly funded, it means it gets most if not all of its money strictly through taxes so a bit comes out of everyone’s paycheck. And most services are free at point of use. Meaning most of the time, you’ll actually pay for nothing up front.

 

And there are of course some exceptions with like dental, vision and prescription drugs but even considering those, they are still relatively inexpensive compared to what you might find in the US.

 

The way it works is, there is a primary structure where you would see a general practitioner or a “GP” much like you would see your primary care provider or your “PCP” in the US as your primary point of care. 

 

Their secondary care is reserved for specialists or hospital care usually requires a referral from your GP. This I guess “gatekeeping” system really helps triage the most urgent cases to secondary care and less urgent cases to primary care to more efficiently use medical resources which is very important in an exclusively public healthcare system which we’ll talk about in a bit.

 

The NHS, I am told has a major focus in preventative care and health promotion which is great, I love that idea because it’s generally better to prevent disease than it is to treat it.

 

And quickly let’ s talk about pros and cons.

 

Pros:

1. Universal Coverage: Everyone has access to healthcare services without worrying about upfront costs. Immediate stress relief for most people! I’ve personally seen some absolutely crushing deductibles for some patients and I can definitely see the stress it causes seeing a 3-4 digit bill for just 1 month of medication.
2. Cost Efficiency: Because all costs are managed centrally, it’s incredibly efficient to buy in bulk to keep costs down… and then disperse those resources accordingly.
   
   In contrast to here… in US pharmacies… 
   1. We have wholesalers purchasing from manufacturers with potentially different contracts. 
   2. Then our pharmacies are purchasing medicines from wholesalers with different contracts which means, potentially different prices.
   3. Insurances companies and pharmacy benefit managers have different contracts with pharmacies which leads to different reimbursement rates
   4. All if this together creates a system that has extremely little transparency. Nobody knows who to blame or what’s going on in a lot of cases.
3. No Direct Billing: Patients don’t receive bills for most services. This doesn’t only mean less stress for patients… this also reduces the administrative burden of managing health insurance. I couldn’t tell you how many hours a day goes into coordinating with insurance companies and doctor offices to get medicine paid for. And very few people will get their medications without insurance because medicine in the US is TOO DAMN EXPENSIVE.

 

Cons:

1. Long Wait Times: One of the most cited criticisms of the NHS is the long waiting times for non-emergency treatments and elective surgeries. If you know that you could go to the doctor for just about anything and incur no bill, you would go, and you should!
   
   But everyone can too, and that creates a high demand of services with resource limitations, patients can experience delays for appointments, tests, and treatments, which… can sometimes affect outcomes.
2. Funding and Resource Constraints: The NHS is funded primarily through taxes, and over time, the demand for services has increased faster than the funding available. And this isn’t unfamiliar with us here with our government shutdowns and staffing issues. But this often causes budget cuts, staff shortages, and an overstretched system, particularly in mental health services and specialized care.
3. Limited Patient Choice: Under the NHS, patients have limited options when it comes to which doctors you can see.
   
   This lack of choice can be frustrating for those who want to have more control over their care or access treatments from highly specialized providers, especially if they are far from where the patient lives.
   
   And this isn’t too foreign to us as well, as we discussed before, many of our health plans here have preferred providers where seeing an out of network doctor would end up being financially… impractical for a lot of people.

 

Despite these cons, the NHS ranks highly for global healthcare systems.

Japan

 

Now let’s look at Japan. Still universal healthcare but a very very different situation.

 

Japan’s healthcare system is still a universal healthcare system, but unlike many other systems that rely on government-funded programs, Japan operates on a mandatory health insurance model which you might remember President Obama attempted to do as well, because it ensures sufficient pools of money for redistribution.

Every citizen and resident, regardless of employment status, must be enrolled in health insurance—either through their employer or the National Health Insurance (NHI) system which takes care of the self-employed, unemployed, and retirees. This ensures that everyone has access to healthcare, no one is left uncovered, and funding remains roughly consistent.

 

Now, you might wonder—how does Japan keep healthcare affordable for such a large and aging population? Because unlike the NHS, funding isn’t completely government regulated. It’s not solely through taxation so it’s not free at point of care.

 

Just having insurance isn’t the cure-all, the panacea to costs of healthcare and that’s very clear here in the US.

And the answer lies in the way the Japanese Ministry of Health controls costs, particularly through something called the national fee schedule. 

 

I love this concept.

Every two years, the Ministry updates this fee schedule, and they dictate the exact price of every medical service and procedure, from a routine doctor’s visit to complex surgeries. Whether you’re visiting a small clinic in rural Japan or a major hospital in Tokyo, the prices for treatments are the same. 

 

There’s literally a book where you can look up like, a cut of this size is going to cost this much. A an overnight hospital stay is going to cost this much for a private room, or a shared room. Everything is transparent.

 

This system gives the government tight control over healthcare spending, ensuring that costs don’t spiral out of control like in some other countries. 

 

Doctors, hospitals, and even private providers have to adhere to these government-set prices. 

 

This standardization of costs also means that private healthcare services are much more integrated into the public system, compared to what we see in places like the UK’s NHS.

 

Patients in Japan pay a portion of the costs—usually 10% to 30%—depending on their income and age, which is also very interesting. 

 

But even these out-of-pocket costs are capped to protect patients from excessive medical bills. The government essentially guarantees that no matter what kind of healthcare you need, it will remain affordable, and you’re likely not going to go broke, and you’re less stressed about seeking care.

 

And then there’s the cost of medications. The Ministry doesn’t just regulate healthcare services—it also keeps a close eye on the price of drugs. Every year, drug prices are reviewed and, if needed, adjusted. 

 

If a cheaper, generic version of a drug becomes available, the government reduces the price of the brand-name equivalent, ensuring that patients always have access to the most affordable treatment options.

 

In contrast to here in the United States, our prices are strictly market driven so drug prices can be highly variable and often times out of control for brand name medications.

 

Yet, for all of its strengths, Japan’s healthcare system isn’t without challenges. 

 

Japan’s universal healthcare system provides easy access to care, but this has led to overutilization—with patients averaging about 12 doctor visits per year, compared to 5 in countries like the UK. 

 

With out-of-pocket costs typically between 10% to 30%, and annual caps on spending, many people will go to the doctor for minor stuff, which burdens the system. This contributes to overcrowded clinics and hospitals, especially in urban areas, where wait times for serious cases can be delayed due to the volume of non-urgent visits.

 

The national fee schedule sets low, fixed prices for all medical services, ensuring affordability but sometimes incentivizing unnecessary treatments. 

 

Providers are paid on a fee-for-service basis, which means they’ll get paid for more stuff they do (which isn’t uncommon), but if they’re not paid enough, providers might be pressured to do more unnecessary things like excessive tests or follow-up appointments because they want to get paid. 

 

Also, these low prices have hurt private hospitals, which account for about 70% of all hospital beds in Japan. A lot of them struggle to stay profitable because of how cheap care is, and some have even closed or reduced services.

 

Overutilization adds to the strain on Japan’s healthcare spending, which is around 11% of its GDP, one of the highest in the world which is super ironic because we’re talking about cheap healthcare.

 

While individual patients pay little out of pocket, the cumulative costs of going to the doctor so much increases the burden on the system, especially as the country faces a rapidly aging population. By 2050, over 40% of Japan’s population will be aged 65 or older, further stressing the already overburdened healthcare system.

 

But despite those drawbacks, Japan’s healthcare system still outranks our own on every list I’ve come across. Probably because too much care is always going to be better than no care at all.

 

Can we do it?

 

Now that we know what healthcare systems are available to model… can we do it here in the US?

 

What would it take and what’s stopping us?

 

The US has been talking about it for a long time and it seems to have tremendous support so why hasn’t it happened yet?

 

We’re going to find out, next episode, so definitely stay tuned for that.

 

Again if you enjoyed the content, consider following and I’ll see you next time.

 

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