Definitions for a Discussion of Univeral Healthcare

Universal healthcare is going to be a political issue again under the Biden administration and probably will be for the foreseeable future.

Before anyone talks about healthcare, they should define their terms. I define healthcare as the large system that is supposed to deliver actual care related to health. This care is usually delivered by health professional like physicians, nurses, therapists and others.

Healthcare is about insurance, Medicaid and Medicare, hospital systems, health economists, policy-makers and so on.

Providing health care is complicated, but the systems of healthcare are complex, in a technical sense.

Universal healthcare is a system where nobody goes without some form of coverage. One way of accomplishing this is single payer. Paradoxically in the US, people are talking about multiple single payers; one for the military and the VA, one or the poor, perhaps one for the elderly, although expansion of Medicare or Medicaid to the general public is one way to achieve a large single payer that coves the majority of Americans. That’s where “Medicare for All” comes in. What most people mean by single payer is the elimination of health plans and other middle men who finance health care. Some people refer to single payer as a true one payer for the entire country, much along the line of the French system.

I define insurance as an agreement with a private or public entity that protects against financial catastrophe by assuring compensation for losses in return for a premium. In the US, we cannot speak of health insurance since it has become a financing mechanism for every virtually type of care, no matter the cost. What we call health insurance is merely a mechanism, for funding care. Low price services are covered which makes them more expensive and raise premiums. The administrative cost is high; think of $20 to get the average claim out, compared to a $20 brace. Now it’s a $40 brace.

It is better to talk of these as health plans, which are prepaid based on an actuarial estimate of total annual expenditures for a given individual or group of individuals. The premium is set at about 1/3 above the average (technically 1 standard deviation above the mean.) This means the insurance company will win two years about of three, There are a lot of ways to maniputale this estimate and the set price of a premium.

Some people, myself included, refer to universal access to health care. To me this implies that everyone can get to a doctor. Some may have to pay, if they can afford it, but there would be financial support and resources for those who could not. The level of support would depend on income and the potential cost of a specific treatment. But here we are getting ahead of ourselves. Universal access implies some sort of blend of true insurance with out-of-pocket expenditures.

Now that we’ve defined our terms, we can then talk about the pros and cons of single payer. That will be the subject of the next post.

Time to Reboot the Old Blog

It may be time to reboot the old blog. My social media presence has increased and the discussions have become more intense. More importantly the tendency for people to twist my words and misrepresent my position has become intolerable.

A case in point has involved my departure from Vaccinate Washington. In a discussion with my co-founder, I expressed the need for caution in establishing COVID-19 vaccine mandates for children. Maybe it’s because she is a teacher, but she responded with great hostility and dismissiveness.

It seems that the political polarization I saw coming in my last blog has deteriorated to the point that everyone is consciously deciding to misinterpret anyone who introduces a bit of a grey area into their discourse.

For example, just prescribing caution about children’s vaccine mandates provoked a “medical freedom” activist to contacted me with an invitation to be on his podcast. I didn’t think that was wise.

I am a radical centrist, part of the alt-center. I won’t easily allow myself to be mischaracterized.

So the plan is to start writing a couple of blog posts a week and to look for media mentions from the past couple of years and back date them. I may well transfer all the posts from the past that are currently hidden. This blog was active from about 2007 to 2016 under the moniker “The Physician Executive.”

Keep your eyes on this space as I start posting more and varied media, both old and new.