Thursday, June 4, 2009

Public Health Insurance - a lifesaver for the American Health System

There is much debate around the type of insurance proposals that will be required in the new health system currently being negotiated in Congress. President Obama has just come out in support of a public health plan, which is opposed by private insurers who say that they could not compete with a public health plan that didn't have to make a profit. Supporters of the public plan proposal correctly say that it would give people more choices and create more competition. Opponents argue that private health plans would go out of business, leaving only an entirely government-run health care system.

Of course all sides are exaggerating and taking up extreme positions. They will all in time compromise and hopefully reach some form of agreement. The sad part is that at present they don't seem to be thinking of the person at the center of all this - the patient. It is widely acknowledged that healthcare costs far too much in this country, while at the same time at least 47 million Americans are uninsured. So, from a patients perspective, if you do have health insurance, you are paying way too much for it, and getting poor value, and if you don't have it, then you just continue to suffer. What a dreadful choice.

The goal of overhauling the health care system is to lower costs and extend care to the uninsured. Obama wants a bill on his desk in October. Where can Congress begin to compromise, and why is it that Republicans in particular, believe that public health plans are likely to be so dreadful. They regularly bring up the ogre of "socialized medicine" whenever public plans are discussed, but there is no evidence whatsoever that countries with more federal control over their health systems, especially in Europe, have worse health outcomes that the USA. In fact the contrary is true, health outcomes are much better overall, for a lot less money per capita.
As a physician who has lived and worked in the USA, Australia and Britain, and who has an interest in how health services are organized, I think we could move forward in a relatively simple way as long as we always keep the patient at the center, and don't try and design a health system primarily to protect profit levels for various constituents, whether they be providers, health insurers or pharmaceutical companies.

Firstly we need a public-private partnership philosophy. That means public and private, not just private. America is founded on capitalist principals, where the profit motive is central, and any new approach to healthcare must combine this with the need to develop core public services that may be less likely to ever achieve a profit. Funding for care needs to be provided on the basis of annual or episodic whole of person care, rather than on individual piece rates as at present. The primary importance of this approach is that it will force more resources into the prevention of illness - to wellness promotion - rather than into the treatment of illness that has already commenced. This is an approach that Kaiser Permanente is well known for.

The public component of the healthcare system would include universal basic health insurance (including catastrophic care insurance) and many emergency and isolated health services, as well as much more public health focus on prevention and health promotion. Public programs should also pick up much of pre/post natal and early child care to ensure all mothers and babies are properly looked after, and probably care of some special populations who cannot afford private health insurance such as the unemployed, some seniors and certain impoverished or geographically isolated groups. These are areas where there will be less competition with private insurers who have typically kept away from them.

The private component would be funded with the aid of tax incentives to encourage most people (or companies) to take out private insurance with aim that at least 80-90% of the population should have private insurance. It is crucial to reach this level of insurance to be confident that we all have "skin in the game" and are financially responsible for at least a good proportion of our healthcare costs, and do not see healthcare as something that is provided by the government for free. The private sector should offer a full range of services from birth to death - with the ability to charge extra for certain "non-essential" services such as cosmetic surgery and other niche areas - but with regulation to prevent people being excluded on grounds of pre-existing conditions.

These ideas are taken from what I consider to be the best parts of the American, British and Australian health systems. No country has a perfect health system. America is the Land of the Free and can afford to choose the best of what other countries have attempted as it debates how to improve its healthcare system. Lets hope that Congress can be creative and not get bogged down in political dogma.

Peter Yellowlees MD has recently published “Your Health in the Information Age – how you and your doctor can use the Internet to work together”. It is available at and most online bookstores. A shortened version of the book, available as an e-Book for download to iPhones, Blackberry's, PDA's and other mobile devices called "4 Simple steps to Better Health - an Insiders Look" is available at Smashwords at

1 comment:

  1. very lengthy but interesting blog i like it that why i am commenting on it :).

    Walk in Clinic
    Diet Menu.