No Easy Route to Universal Healthcare in the United States

Roxanne Nelson, RN, BSN

September 12, 2019

"The healthcare system in the United States results in serious medical, socioeconomic, and psychological burdens among American patients, particularly patients with cancer," say the authors of a new article.

In most other high-income countries, healthcare is considered a human right and operates under some type of universal system.

In contrast, the US operates under a fractured and for-profit system.

So, they ask, "How do we change the current US system into a healthcare system for all?"

In a personal view article published online on August 28 in the Lancet Oncology, a few suggestions and solutions are offered by Greg Jones, BS, from the McGovern Medical School, University of Texas Health, Houston, and Hagop Kantarjian, MD, a nonresident fellow in health policy at Rice University's Baker Institute for Public Policy, Houston.

Kantarjian is also professor and chair of the department of leukemia at the University of Texas and has long been vocal about the high prices of cancer drugs and, in particular, critical of recent price hikes for leukemia drugs, as previously reported by Medscape Medical News.

Roadmap to Universal Healthcare

Universal healthcare systems exist in other countries and vary considerably, with some offering public single-payer systems, some government-supervised private insurance plans, and others a combination of the two, the authors write.

In the United States, healthcare coverage is currently a complex mix of for-profit private insurers and public systems. But a substantial proportion of Americans lack any health coverage, the authors emphasize.

The implementation of the Affordable Care Act (ACA) reduced the number of uninsured Americans, but as of 2019, about 29 million people remain without healthcare insurance.

This number of uninsured Americans is still unacceptable and arguably immoral.   Greg Jones and  Dr Hagop Kantarjian

"This number of uninsured Americans is still unacceptable and arguably immoral in a large, advanced, rich country such as the USA," the authors argue.

Major progress was made with the ACA, but it has subsequently been weakened and challenged in recent years.

Although far from perfect, the ACA was a positive and important step in healthcare and "weakening it for political and ideological reasons serves no good or moral purpose, and results in difficulties for the most vulnerable Americans," the authors comment.

Rather than the "Repeal and Replace" legislation, which has been proposed on numerous occasions, they suggest that a policy of "Remedy and Restore" could help solve the ACA's shortcomings.

A number of other proposals are under consideration. They can broadly be defined as a universal system that is publicly run and eliminates private insurance, or an incremental one, which would be a gradual expansion of Medicare while keeping the current insurance system intact, the authors explain.

Expanding the Medicare system to cover all Americans (Medicare for All) or at least expanding the age range (50-55 years or older, Medicare for More) is a hotly debated topic among Americans and presidential candidates. The initiative was proposed as an amendment to the original ACA, but in order to gain support from private insurers it was removed before the final legislation was implemented.

Americans also tend to shy away from having a single-payer public option that excludes private insurance, Gates and Kantarjian point out.

Most people (70%) with employer-based coverage claim they are satisfied with such coverage, and the single-payer public healthcare system is also highly vulnerable to "inflammatory political campaign slogans (eg, 'socialized medicine', 'medical communism') that could sway many Americans against a public healthcare system," they comment.

Thus, to create a roadmap that most Americans will approve of, healthcare proposals should keep the current private insurance system and but also offer Medicare and Medicaid coverage to more people instead, they suggest.

"Any reform must also remove restrictions on the abilities of government programs to negotiate bulk drug prices, and must cap premiums, out-of-pocket expenses, and deductibles to affordable levels that do not lead to an abandonment of care, bankruptcy, and, ultimately, death," they add.

Allowing broader government-sponsored programs that can run parallel with private insurances "will, through incremental steps, uncover the best healthcare system for the USA," they conclude.

Lancet Oncol. Published online August 28, 2019. Abstract

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