Integrating Our Way Toward Universal Health Care in America

Posted on | April 29, 2016 | 1 Comment

Source: Consumerist

Mike Magee

Would you be willing to subject yourself to a 3.3% payroll tax (and your employer to a 6.7% payroll tax) to gain access to reliable simple universal health coverage – one that provided choice in and out of network, one that would cover all citizens, and one that has drawn the active opposition of health insurers? That’s the $38 billion dollar question facing Colorado voters in the near future.

Colorado supporters have arrived at this point through a rational process that began with advantaging Obamacare with the expansion of state Medicaid rolls, and navigating bronze, silver, gold and platinum options. But in the end, as the system attempted to move toward low cost/high quality goal posts, which contractually continued to include insurer middle-men draw downs and embargoes on drug price negotiation, all roads led toward universal care and universal management as simpler, better, and (for almost everyone) cheaper in the long run approach, supporters said.

A similar process was proposed this week in a JAMA article titled, “Toward an Integrated Federal Health System”. In it, the authors review the facts, including:

The federal government spends $1.3 billion a year (40% of all health care spending), on health care.
This budget funds coverage through the departments of Health and Human Services, the Department of Defense, Veterans Administration, and the Department of Homeland Security.
The payments channel through a bewildering array of mechanisms and middle men – through private insurers, private health professionals and organizations, and direct services to covered patients.
The complexity is mind-boggling. For example, 42 programs exist across 6 federal agencies for ambulatory transportation of the elderly and disabled, each with their own rules.
Drug payment levels vary widely. DOD pays 67% more for generic drugs than the VA for example.
Double payments are not uncommon. Approximately one million citizens are now simultaneously tapping in to both VA and Medicare Advantage payments with losses estimated at $3 billion a year.
Brick and mortar duplications, and in-patient underutilization is legendary.
The DOD and the VA electronic medical records are moving forward toward integration this year – which should allow inter-operability and mobility/virtual choices for services to proceed.
HHS expects that 50% of Medicare payments will have been converted from fee-for-service to “value-based models” (bundled payments with quality performance incentives) by 2018. Seven states will apply this approach to their Medicare Advantage plans beginning in 2017.

If all of this sounds complicated, multiply it by 50 states, and you begin to understand why supporters in a state like Colorado are seriously considering pulling the plug and going with a simpler universal solution.

Are we approaching some consensus? Will integration morph eventually into universal and cut the middle men out of the deal? Where are the consensus points emerging? Here are four areas:

1. Eliminate “fee-for-service” payment methodologies.

2. Move toward universal coverage, eliminating low benefit scam plans.

3. Integrate patient-focused EMR’s regionally, then nationally.

4. Favor non-profit solutions, and integrated delivering systems whose mission incorporates individual, population and community health.