More Universal Magic by Pat Conrad MD

Last year Forbes had an article suggesting that the fix for our health care mess is pricing transparency:  “‘Single-Payer’ Healthcare Isn’t Necessary — But Single Pricing Is.”  The author’s point is that our entire debate premise is wrong, because our entire tiered system leads to price obfuscation, and downright opacity.

Okay, I’ll bite.  How do we get that transparency?  The author Dan Munro’s answer is simply, “universal coverage.”  He states, “The only way to lower the cost is to end coverage,” which makes sense.  It’s confusing (to me) because he seems to contradict himself.  “Payment and coverage are definitely connected, but that connection can and should be simple and transparent–not complex and opaque. Universal coverage is that simplicity and transparency.”

So how does that happen?  Here the author takes a dive:  “Obviously, how universal coverage is paid for (either single- or multi-payer–delivered through government or privately owned industries) is a critical debate, but who qualifies for coverage (and under what terms) shouldn’t be.”

Munro says that the three arguments against universal coverage are clinical, fiscal and moral, and that they all fail.  He claims a modest but measurable 20% drop in all-cause mortality for the insured.  He states that our $10,877 per capita annual expenditure on health care does not invalidate universal coverage because other nations with US have lower per capita costs and better longevity.  Munro cites Germany circa 1883, and a Martin Luther King, Jr. quote as his proof of the moral imperative.  He doesn’t take issue with Bernie Sanders “Everything-Is-Free” care, and only decries the money:  “At almost $11,000 per capita per year, our healthcare system is a gigantic monument to the priorities of ‘shareholder value,’ inequality and injustice–at scale.”  Munro calls out the bad guys:  “Payers, providers, pharma, suppliers, educators, software vendors and medical device manufacturers are all harvesting enormous profits from our $3.4 trillion ‘medical industrial complex.”

He thinks the only real debate over universal coverage is payment mechanism, and the other problems would all be solved with single pricing and ending annual enrollment.   And “because we don’t need single payer to get to single pricing.”  If there is truly single pricing, then who sets the price?  Which gets me back to Munro’s list of culprits above.  He does say “payers”, but I question whether in his mind that includes government, because that is certainly who will set prices.  And when they do, the big health corporations will cease offering less profitable services and meds.  Oh wait, that’s already happening.  And Munro conspicuously omits another group of culprits:  patients and family members.  Like every other universal coverer, he makes no mention of patient accountability, or patient/family expectations.  How would he fund the recalcitrant smoker?  How would he protect the hospital that wants to discharge an advanced dementia patient from the ICU with sepsis, with no spare beds and the ER backed up with patients who are all covered?

Experts from all walks keep coming up with “solutions” that never address exactly who or how all of this is paid for, and when and how someone will be told “no.”

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