Last week’s Grand Rounds was hosted by Edwin Leap, and includes all sorts of interesting healthcare articles. One that caught my eye was from Dr. Rich at the Covert Rationing Blog, writing about strategies for the battle over universal healthcare.
Dr. Rich’s article delves into the sticky subject of how to get around a ban on patients being able to pay directly for their own medical care in the event (highly likely, as he sees it) that the US adopts universal healthcare and bans private purchase of healthcare outside of the government-run system.
I’ve written about the NHS and bans on private purchase of expensive pharmaceuticals that are not covered by the UK’s government health care system. I can see the logic behind such government bans, but if a person chooses to forego a new car and spend her money instead on healthcare benefits that are not covered by her healthplan, I believe she should be able to do so without becoming an outlaw.
Here’s the way I see it: currently, we have 47 million people in this country who have no health insurance at all, and thus no realistic access to healthcare. The implementation of some sort of basic health insurance to allow everyone access to care is the first step. And I truly believe that everyone should have access to at least basic care before the wealthy have access to extraordinary care.
I agree with Dr. Rich that prohibition doesn’t work. It doesn’t work with drugs or guns or prostitution, and it won’t work with healthcare. Before abortion was legal in this country, women still had abortions. Poor women had backalley abortions and often suffered horrendous trauma or death as a result. Wealthy women went to countries where safe abortions were readily available. This is a perfect example of what happens when the government tries to ban something that a portion of the population want or need – healthcare is no exception (and given the importance of healthcare and the fact that a life or death situation might be at stake, I can’t think of a scenario where people would try harder to get something outside of the official system if they deemed it necessary). Dr. Rich’s prediction that medical tourism would boom in the event of a ban on private pay healthcare is exactly correct.
Perhaps I’m just an eternal optimist, but I believe that if some sort of universal healthcare system is put in place in the US, it will cover all necessary and proven treatments. So hopefully the only treatments that people would be seeking outside of the government system would be experimental ones. That’s not to say that experimental treatments shouldn’t be administered, just that the problem of not being able to access care through a government health system would hopefully be the exception rather than the rule.
Medicare is an example of a universal healthcare system (for the over 65 population and those who are deemed disabled). It also has private sector involvement in terms of Part D and Medigap plans. People with money can choose very comprehensive supplemental coverage for Medicare. Those without money can choose just basic Medicare (although they could end up in financial trouble if they need expensive treatment). What if a similar system were to be enacted for the whole population? Expand Medicare to cover everyone with very basic health insurance. Then allow people to purchase private supplemental plans if they wish, with a wide range of options available to fit various budgets (similar to what we have now in the private health insurance market, but with the understanding that the plans are in addition to a basic policy provided by tax dollars). Wealthy individuals would be able to buy the best supplemental coverage, giving them access to the best care. Is that fair? Maybe, maybe not (the answer might depend on how big ones brokerage account is) But at least everyone would have basic coverage.
Hopefully the Obama Health Team reads Dr. Rich’s blog. I believe that any form of outlawing private pay healthcare in a universal healthcare system would be doomed (as is the idea of any prohibition, really). Taking a helicopter ride out to a Liberian-registered nuclear aircraft carrier that has been retrofitted as a swanky hospital (would there be a spa service, I wonder?) would add a whole new level of excitement to healthcare. But I think that most of us would rather continue to be able to seek healthcare options a bit closer to home. A little government intervention in terms of providing affordable basic healthcare access to all Americans through a tax-funded program is a good idea. But too much government intervention, in the form of a moratorium on private pay healthcare, is a bad idea.
The Colorado Health Insurance Insider article about attracting more docs to primary care was included in this edition of Grand Rounds. Thanks for hosting, Dr. Leap!