The two choices in health payment structure are single-payer or multi-payer. Single-payer systems push all health funding out of one party: the government. As a result, multiple insurance companies are eliminated, except for those offering private supplementary insurance for the affluent, which serve a niche function and are of no bother to efficiency. The elimination of these multiple insurers and their wasted spending and overhead could save the American health system as much as $300 billion a year, paying for Universal Coverage for the 50 million uninsured Americans in our country by 1.5 to 2.0 times in just one fiscal year.
Single payer also gives the government enormous leverage over drug and device companies. By serving as the only entity paying for their products, the government decides which products are reimbursable for treatment. This significantly lowers prices for consumers and discourages drug and device companies form manufacturing copycat products with insignificantly improved efficacy.
2. The universality of Care / Coverage
The universality of care and coverage tie into payment structure. Ultimately, the goal of health policy is to cover every man, woman, and child, something that every industrialized country other than America does. It is very hard to ensure true universality of coverage without a single-payer system. This is because, under multi-payer systems, payers are private and try to find reasons to exclude sick patients, which they callously term "bad risks" or people with "pre-existing conditions".
In insurance, the technical term for every dollar spent on care for patients is actually known as a "Medical Loss Ratio", or "MLR". Patients are a loss to insurance companies and that is how private insurers/payers view the general public.
Under single payer, the government writes all checks and not only guarantees service for everybody but, also, holds back on unnecessary treatments that currently waste money in our system.
3. Tort/Malpractice Reform
The unwillingness of the Executive and Legislative branches of our government to work on malpractice reform is handicapping our health system. While there is no question that, to some extent, care providers order unnecessary procedures and tests to generate income, it has been studied that the supermajority of excess medical treatments are ordered due to provider fears of legal repercussion.
The total direct and indirect effects of defensive medicine on our health system are huge. While econometric studies show a neutral bias on direct and indirect costs, it is crucial to consider the psychologically indirect costs of extra physician diagnostics, testing, and procedures, which is crudely captured in such studies.
Whether you look at extreme examples such as Nassau County, Long Island, where OB-GYNs are strangled with malpractice bills well over $200,000, or more mainstream examples, such as doctors in community hospitals who overload on diagnostic work, the primary and secondary effects of lawsuit fears are tremendous.
This is a hard issue to move on because of the close love between legislators, their legal colleagues and the ABA, but it is an essential part of true health reform that is, unfortunately, seemingly off the table and never mentioned by the President or those in Congress.
4. Trust Fund / Tax Issues
There is not enough money in the coffers to fund our current system of healthcare or the Medicare trust fund. I raise this point in this manner because, often, people reject the prospect of tax increases because they don't want to pay for EXPANSIONS of care or MORE care. I am merely talking about our existing system. We need a 4-6% tax increase on the top 5% of income earners just to sustain our current system and for America to not go bankrupt. I actually believe, in the long-term, that Universal Healthcare will pay for itself. We do need more money for healthcare and for Universal Healthcare, but we would need that same amount of money right now, even if nothing changed. A 5% tax increase would be needed for the current system too, not just for Universal Healthcare.
5. Primary/Specialty Care Balance
All other industrialized countries have a primary/specialty care balance in a ratio of 3/2 respectively. In America, the care ratio is 2/3. Specialists cost more money and do not provide enough front-line support for basic preventative care and initial examinations. In socialized countries, there is a much heavier reliance on nurse practitioners, midwives, and physician's assistants. Furthermore, a much higher ratio of primary care doctors to population is allowed to graduate. Adding care for 50 million people will require much more primary care. Again, however, even under our current system, numerous studies show that we would have better care outcomes, and much lower costs, if we loaded up on lower-paid primary care providers instead of relying on a system filled 60-65% with many higher-paid specialists.
As an example of the excess costs created by a high specialist-ratio system of care providers, a New England Journal of Medicine study found that, on average, specialists earned as much as 25% more than their primary care counterparts for performing medically equivalent services that took the same amount of time and had statistically similar medical outcomes. This is wasted cost that could be eliminated.