The big discussion on the left to implement universal (single-payer/government/whatever) healthcare does not address a few issues I have with the current system. This isn’t to say there aren’t valid argument in favor of universal (single-payer/government/whatever) healthcare, but this post I want to lay out some other aspects I believe need to be solved for. For the rest of this post I will just call the concept “universal healthcare” since there isn’t a more accurate term I know. Universal healthcare isn’t going to solve these and I think they are ALSO problems seeking good solutions.
People Problems
Universal healthcare doesn’t address the issue we have with getting high quality doctors, specialists, and nurses into the eco-system of the healthcare world. Every country I have looked at (Germany, Canada, Netherlands Japan, and the UK) ALL have issues with doctor shortages. I have heard for years and years how we can’t go to universal healthcare because “in the UK and Canada you wait weeks and weeks to see a specialist!”
You know what? I wait weeks and weeks to see my pulmonologist. She is usually booked 2-3 weeks minimum out from the current date. I try to keep my setup 6-month appointments when I leave the office so I can get a reasonable office visit time, but there is almost always a negotiation because she’s already booked. And she’s in a group with a good 10 doctors or so, and they are ALL booked up like that. And they are specialists.
So the argument that universal healthcare will somehow make people wait for a specialist…. I do that now. I would like to see this solved. We need to empower students to study biology. I think we need to subsidize medical schools so they are more affordable or something. We need to build up the workforce for doctors, nurses, and specialist technicians (respiratory techs are specialists who might be nurses but not always).
Bureaucracy
A few years ago, my insurance said they wouldn’t cover my daily asthma medicine any more. It is an expensive brand-name medicine, so my doctor wrote me a prescription for the “generic” version of a daily maintenance medicine. It didn’t work. So we tried the brand name version my insurance would cover. I had an allergic reaction and ended up in the ER. My insurance then approved the original medicine which had been working for the previous 4-5 years. I’m sorry they keep changing the formula slightly to keep it under patent. I really am. I have sympathy that my 30-day supply is like $450 without insurance.
There are tons of stories where doctors have to follow a script of care which the insurance company requires before they will approve XYZ. I know several people with issues who go months and years fighting to get the care they need. The care their doctor identified from day one as “the best, logical solution” but the insurance company requires “proof?” that it really is necessary (example of a friend who’s doctor needed an MRI and couldn’t get approved until the person had gone 6 months of Physical Therapy first).
Again, one of the common complaints with universal healthcare in the countries which get touted as the examples (see my list above) is how annoying bureaucratic hoops are. And you know what? I can’t even say “just get rid of it” because doctors are only human. All it takes is a few lazy or greedy or stupid doctors to abuse the trust and drive the pendulum back to “we need to give the doctors a script because we don’t trust them to make smart decisions on their own.”
Trust
Doctors are only human. They can make mistakes. They can have poor judgement. They can (and do) have biases. Anyone I know who has done anything more than “I go for my annual, I’m always healthy” generally has at least one story of when they realized they lost trust in a doctor. One of mine is when I had been struggling for a YEAR to lose weight. I had just finished 10 weeks on the South Beach diet with my roommate (she lost like 10 lbs… I lost nothing). I had started going to the gym 3x a week. I went to my doctor and nearly in tears, asked what was wrong with me. Her response, “You just need to start working out 2 hours a day every single day” (14 hrs a week).
She might have been right, but that was just physically impossible. I was working 40+ hrs with a ~60m commute each way… I would literally just be working and going to the gym to try to meet her suggestion. (and I hate the gym).
I had a dentist tell me no man would marry me unless I got braces (post college no less). I’ve gone to doctors and they treat me like a number where they don’t look at me. I’ve refused to fill prescriptions because what they told me they were putting in and what the pharmacist was giving me were completely different and not “generic vs. brand name” – I mean they told me they were prescribing me a steroid and when I get there the pharmacist was sent an antibiotic by that doctor. They call the doctor and the doctor confirms the antibiotic. Either the doctor lied to me about what they were giving me or why or…. I don’t even know. I refused to fill the prescription and went to a different doctor who I could trust.
Conclusion
I don’t necessarily expect universal healthcare to solve these – the last one it isn’t even on the docket anywhere. But they are things I think need to be addressed somehow. I don’t want to hire and promote “just anyone” to solve the first problem because of the third problem. More people means more potentially bad doctors to fear. We need more doctors. We need a way to vet doctors. We need a way to trust doctors to make good health decisions on my behalf.
These are hard issues, and need smart people to come up with really smart, creative options.
Dream by Day 