Analysis by Reporting San Diego
March 28, 2017 (San Diego) State Senator Toni Atkins is behind a bill that seeks to create a single payer program for California. One of the models at play is obviously Canada’s. This is a country where single payer started in a single province, bucking a private medical system, that spread to the rest of the country. These days the Canadian system is a very successful single payer system. One that Americans know the best, even if the French system is even more successful.
While Democrats in general and progressives in particular, speak of health care as a basic human right, there are reasons to implement such a system. This is not just coming from a place that seeks to expand what we think are human rights. These are policy reasons that have to do with a healthy work force and public health.
The first question that any policy maker has to ask is not an emotion-laden will an increase rights, but rather a cost-benefit analysis. Given that the American health care system is the most expensive of advanced economies, with the worst outcomes, that alone says we can improve the system. We can make it far more efficient and cost effective. To do this, we need to change how it works, however.
There are questions of policy that need asking. Not just the common but critical issue, how are we going to pay for this? But also who is going to have access to the system? If we look at this policy as a public health matter, excluding people because of migratory status is counter productive. Why? While this is a small percentage of the population, that still lives in the shadows, in the case of a medical pandemic, they can be the source of infection. Not because they are here illegally, but because a lack of access to medical providers means no medical oversight and easily could escape the attention of medical providers. Therefore, all state residents need to qualify for this kind of a program. It makes good public health sense.
Moreover, if part of the taxation necessary to fund this program comes from things like sales taxes, these people are paying for the service anyway. If this comes from payroll deductions, like Social Security and Medicare, they will be paying for it. Where it will get trickier is with both American and foreign tourists. A visitor will end up in the emergency room. Why? Accidents happen. So who will pay for that medical attention? Tourists are not necessarily planning to use our services, but they will end up in the hospital, and if medical care is a right, which it is, they cannot be denied attention. In fact, by Federal Law, they have a right to that care.
If they are US tourists and have medical insurance. It will be an issue of charging their insurance provider. In many cases, foreign tourist also has coverage that will cover emergency care in a foreign emergency room. Where it gets more complicated is when that insurance does not exist, either for an American tourist, or a foreign tourist. So how will the system deal with that unexpected cost? Will we have some funds set aside for indigent care? This is not an idle question. Currently, this is how this works:
Under California law, the state’s 58 counties are the “providers of last resort” for health services to low-income uninsured adults with no other source of care. Thirty-four counties — mostly rural and/or small — offer a standard set of benefits through the County Medical Services Program that is run by Anthem Blue Cross Life & Health Insurance Company on a contracted basis. The remaining 24 counties provide their own programs and make their own decisions about funding levels, eligibility requirements, and covered services. Several of these counties offer more than one program.
Then there are the transplant centers and other advanced medical care. UCSD, for example, serves as a transplant center serving patients from as far as Phoenix AZ. How can we continue to serve these patients? Insurance is, of course, one way, but the question on how California research centers continue to serve patients from around the country will remain. They will be funded not by insurance, but state grants. Some of this care is quite expensive.
These are just some of the many policy questions that will rear their ugly head. It is not just about a belief that health care is a right. It is about the costs, very actual cost. However, if the system is designed well, it will be far more efficient and cost effective. In the time it might serve as a model for the rest of the country. This is exactly what happened in Canada.
For that to happen, there are several things policy makers must also concentrate on.
The first is preventive health. Any system around the world that is far more cost effective than the American system does focus its attention on prevention of chronic diseases, such as diabetes and heart disease. This means better diets, and this will have to start with school lunches and overall dietary education of a population. We might have to adopt models such as those that exist in places like Japan or France, where the school lunch is not a hurried part of the day, but integral to the education of students. This school lunch is not eaten in half an hour, but schools have at least an hour for students to sit down and have a nutritious meal Habits acquired early will translate to better diets as adults.
Taxes on sugary drinks have been tried abroad, and do work. The World health Organization (WHO) has asked for such a tax world wide. It does show a slowdown in the consumption of sugary drinks. They are partly responsible for the epidemic of both obesity and diabetes.
According to the WHO press release from 2016:
“Consumption of free sugars, including products like sugary drinks, is a major factor in the global increase of people suffering from obesity and diabetes,” says Dr. Douglas Bettcher, Director of WHO’s Department for the Prevention of NCDs. “If governments tax products like sugary drinks, they can reduce suffering and save lives. They can also cut healthcare costs and increase revenues to invest in health services.”
These taxes would be diverted to the health care system. Add to those smoking taxes and that will be, short term, a way to finance the system. It should also help educate people on healthier habits.
Exercise needs to come back to schools as well. Time for regular exercise, just like healthy lunches, need to be part of the health care system. We need to develop a global view of what is to be healthy. Suffice it to say, this goes well beyond just the doctor’s office. It can start well before a baby is born, and translate to habits throughout a lifetime.
It is very early in the process. So these are just some of the questions that inevitably policy makers will have to face. The savings in health care dollars long term will be significant, however.