A good friend of mine is finishing up his study abroad in Japan. He, like many students who live in an unfamiliar environment for a long time, became sick. Because Japan has a national healthcare system, he was automatically enrolled when he started studying there this past spring. And so, he went to the on-campus clinic, filled out the forms, and got some prescriptions. The whole visit lasted only an hour. The total cost for this visit: $15!!! For comparisons, I usually have to pay a co-pay of $20 just for my annual check-up. He then went to the pharmacy and picked up three different types of medicine. The total cost for these medicines: $5!!!!!! Yeah, sure Tylenol and Motrin might cost me $5 if I go to Target, but that is the price of one prescription.
Nationalized healthcare is just another term for universal healthcare.
In Japan, that means that everybody has access to healthcare and the system is also "free." By free, I mean that it is a public system, and the patients only have to pay a small fee. In this case, my friend only had to pay $20 for his visit and three medicines. The whole process also just took up about one hour of his time.
Here's the important thing about nationalized healthcare. It does not imply that everybody gets everything for free. The government decides what is covered, who is included, and how much is covered. It's as close to a public option that you can get. There are different ways to fund a nationalized healthcare system. Japan uses a social health insurance system that combines public and private providers. You get your insurance through yourself if you are self-employed or through your job or government entity, whichever one that you work for. Insurance ends up paying around 70% of the costs, and the patients are usually responsible for the rest. Again, it is often a nominal amount. Also, those with preexisting conditions can get insurance with no problem.
Sounds great right? Low cost, high-quality healthcare? Who doesn't want that? Well, be careful. Every great healthcare system has its cons. According to the Washing Post, because it is so easy to see a doctor in Japan, the government has been having a hard time preventing people from overusing or abusing the system. Another essential feature of Japan's system is that it does not pay doctors very highly. And so, doctors are faced with long hours and low pay and high stress. This is especially relevant for doctors working in public hospitals.
So can the U.S. have a nationalized healthcare system or something like it?
It's complicated. We have two options on the left. One is Medicare for All, and the other is the less liberal public option.
Bernie Sanders has been a champion of Medicare for All for a very long time now. Under this plan, the U.S. would have a universal healthcare system. It would be a federally administered single-payer health system. Sound familiar? Bernie wants his policy to cover any service with little cost to patients. Bernie's plan also wants to integrate our healthcare system so that we have one big public health insurance system that ensures that patients get the same quality of care. More and more Democrats are supporting Medicare for All, but not all Democrats want to embrace it.
The public option (there really should be a name for it) is a milder version of Medicare for All but still aims to increase the government's involvement in healthcare. It was once deemed as too liberal to be included in the ACA, but now moderate Democrats are embracing it. There have been some variations of it. Democrat Cindy Axne defines public option as allowing Americans to choose between Medicare and Medicaid. Democrat Tom Malinowski supports creating a universal health coverage that people can buy into. For some, the public option is seen as a path to get to the end goal, Medicare for All, but for others, the public option is the end goal itself. However, the underlying common denominator is that these Democrats want to use the government's bargaining power to control healthcare costs. However, when we put pressure on prices, the question becomes how will this affect quality?
Like all policy solutions, we have to deal with the dreaded politics.
Politics in healthcare is complicated and annoying. According to the New York Times, the pharmaceutical industry spends $204 million on lobbying, and the insurance industry only spent $157 million. As of right now, the American Medical Association (the lobbying organization for health professionals) has doled out $6 million in lobbying. We have a system here in the U.S. so entrenched in politics that if we try to do something to increase transparency or decrease costs that we will almost always see these stakeholders fighting back.
When we talk about implementing a public insurance system and getting rid of the private insurance system, we are talking about eradicating some huge companies. Aetna, UnitedHealthcare, and Anthem are some of the most significant health insurance companies. These players have been in the system for a very long time, and so they will not go away willingly.
If the U.S. were to follow Japan's path or something similar, then will our doctors accept a cut to their payments? They most definitely will not take it passively. Even now, physicians are very reluctant to accept Medicaid patients because the reimbursement rate is so low. Rather, if the government is going to decrease payments to physicians, then we need to figure out how much can we cut before we sacrifice quality and hurt patients?
I'm not saying that we can never have a nationalized healthcare system, but when we talk about this, we need to consider the politics. We need to think about how will the stakeholders react? Is it feasible to get to the end goal all at once or do we need to take baby steps? Rebuilding a healthcare system will take years and even longer see benefits come from it. Changing the U.S.' system to a nationalized system will mean that we will be putting patients first. It says that we want to decrease costs but not sacrifice quality. But of course, each system will have its cons. But for now, the question becomes how do we work with the different stakeholders if we want to push for a nationalized healthcare system? How do we make sure that the politics stream allows for the policy solution to pass? If we can answer that question, then maybe we can be on the path to universal healthcare.