(Issued June 23, 2017)
The following is our draft plan for creating a universal, affordable healthcare system for the US. It is based on research comparing systems around the world, interviews with healthcare experts, discussions with constituents, and on the experience of the candidate living in two countries with universal healthcare.
It is the basic framework for how we believe the US system could be fixed to provide universal coverage affordably. It is considered a draft because we are continuing to receive feedback.
Please feel free to send your thoughts on the plan to firstname.lastname@example.org.
Create Universal, Affordable Healthcare
Universal affordable healthcare is a basic human right. And as Americans we pay more than any other developed country for healthcare and have the worst outcomes dollar for dollar. We can do better for patients and for all taxpayers by building on what works in the US system and expanding it to cover everyone.
Republicans have threatened the life and health of all Americans by rushing to repeal the ACA with no viable replacement. This is a political move that endangers the stability of our healthcare system and coverage for most Americans. We are too rich of a country to allow people to die because of a lack of basic and preventive care. Serving the uninsured through emergency rooms is insanely expensive and must stop.
My experience living in two countries with universal healthcare (Britain and the Netherlands) gives me first-hand insight into what would work and what would not work in the U.S. My priority is to make health care more affordable, effective and universal for all. Taking health insurance away from millions of Americans makes no sense. Making it more accessible and affordable for more people makes perfect sense.
My Personal Story
I lived 10 years in Britain, which has a single-payer plan. I had excellent essential and emergency care. There were long waiting times and sometimes frustrating bureaucracy for non-emergency diagnostic tests and specialist treatment. It was, however, far superior to what we have in the US at present. That system costs less than 9% of GDP.
Healthcare in The Netherlands, where I lived for about eight years, is consistently rated the best in Europe, and it costs approximately 11% of GDP (compared with 20% in the US.) It provides universal care, comprehensive coverage, and allows patients to choose their doctors and hospitals. Doctors, hospitals, and insurance companies are profit-making and compete for patients based on quality of care, but prices for all services and medications are agreed upon, and prices are contained. Companies subsidize their employees’ health insurance as an employment benefit, self-employed people don’t pay much more, and the unemployed or those dependent on social welfare receive the exact same coverage. Health insurance is mandatory and there are large fines for non-compliance – less than 1% of the population is uninsured. Deductibles are low – a few hundred dollars a year. Insurance costs are low – I paid less than $200 per month. A typical visit to the doctor’s office was about $40 and insurance reimbursed you 100 percent once you met your low yearly deductible. There are also waiting lists for non-urgent care but less so than in Britain. The Affordable Care Act was modelled on the Dutch system in part, but we failed to implement price controls on services and medicines – something we desperately need in the US but has been unfathomable due to the cozy relationship between the US Congress and lobbyist representing insurers and pharmaceutical companies.
I do not support a single payer mandatory system because currently large employers pay roughly 40% of insurance costs and we cannot afford to replace this in our system. Most people who are employed by corporations, government, universities and other large organizations are happy with their coverage, but would like to see price containment and need to ensure that they remain covered if they leave employment.
I will push legislation that creates universal healthcare but that will work to control prices. The mechanism for this would be:
- Creation of a Healthcare Cost Review Commission in each state comprised of patients, doctors, hospitals, government (Medicaid/Medicare), pharmaceutical companies and insurers (with patients having half of all votes) that would set strict prices for all services and products (drugs). That price would be paid by the patient’s insurer, whether private or public. This has been successfully implemented in Maryland;
- While the commissions could set lower prices, no drug could cost more for Americans than it costs on average across Europe;
- The commission would mandate simplified billing that would limit the fees charged per procedure. For instance, the cost of an emergency appendicitis and all follow up care would be standard across all hospitals.
- Insurance companies would compete for clients but the amount of the premium that could cover administrative costs and profit would be strictly regulated on a federal level;
- Expansion of Medicaid to anyone below the poverty line and subsidies for health insurance to make sure all lower income workers can afford healthcare, funded by increased taxes on the very highest income earners;
- Voluntary expansion of Medicare at cost for anyone of any age as an option to private insurance (and to increase competition to for-profit insurers);
- Mandatory coverage through either private or state plans with significant penalties for non-compliance;
- Absolutely no ability for insurers to charge extra for pre-existing conditions or refuse coverage under any circumstances;
- Require all doctors and hospitals to accept Medicare and Medicaid without discrimination (the price received by them from all patients will be the same, so there is no financial disincentive to them.);
- No limit on staying on employer insurance plans after leaving employment and the ability to switch to another market plan or Medicare, whichever makes more sense, and;
- Remove requirements for employers to provide health insurance for full-time employees – this rule is causing many employers of lower-income workers to limit their hours, keeping the employees in poverty. It is also causing huge financial strain on small businesses. Either make the contribution proportionate to the number of hours worked or remove the requirement all together. Those employees who are lower income will be eligible for Medicaid expansion. Higher-income and professionals will continue to receive this benefit as employers compete for talent.