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The Healing American Healthcare Podcast
The Healing American Healthcare Podcast

Episode 5 · 2 years ago

Universal Healthcare in the US

ABOUT THIS EPISODE

Ed Eichhorn talks with neurologist, biophysicist and co-author of Healing American Healthcare Mike Hutchinson about today’s issues in universal healthcare and what the US should consider in moving towards and presenting a different system of healthcare. 

To learn more about the Eichhorn & Hutchinson “Allcare” health plan and how it can save more than $1 trillion for the US every year, check out their book Healing American Healthcare at Amazon, Barnes & Noble or at our website, healingamericanhealthcare.org  

Hello and welcome to the healing American health care coalition podcast. My name is Ed Ichorn and I'm the founder of the coalition. Today we're going to have a discussion with my co author, Doctor Mike Hutchinson. Mike and I wrote healing American health care, a plan to provide quality care for all while saving a trillion dollars a year. Let me tell you a little bit about my colleague Mike. He is a neurologist and biophysicist. He is senior faculty at the ICON School of Medicine at Mount Sinai in Manhattan. He has thirty years of clinical experience and he has certified in neurology and neuroimaging. Mike is a past president of the American Society of Neuro imaging and he holds a Ph d in molecular physics. Mike convented parallel imaging in one thousand nine hundred and eighty seven, which is now a standard for clinical MRI. Doctor Hutchinson has a large private practice in Manhattan and, in addition to that, teaches and conducts research, including fundamental MRI theory and its application to neurodegenerative conditions. He has recently published the theory of ultrafast Miri and over the last two years he has received two patents for his invention of ultrafast MRI imaging. So with that, let me say hi, Mike. How are you today? Hello. So before or we get into this, Mike, I thought I'd ask you how is your practice changed as you treat patients during the pandemic in Manhattan? It's changed quite a lot. First of all, most of my councils are done over the Internet. You know, with zoom conferencing. We've opened up two days a week instead of five to do procedures, mainly botops and other procedures that I do, and it's changed quite a bit. Everybody has to wear a mask. I wear two masks, my assistant, where as a mask you have to have your temperature checked when you come in and you have to have been within New York City or New York state for the seven days prior...

...to the visit. Numbers are down about thirty five percent, but we're managing well. That's good. So, like, what would you like to talk about today with respect to universal healthcare and the book that we wrote a couple of years ago and today's issues in the universal healthcare. Well, I think it's setting aside the issues of Covid and moving forward because I think, you know, a year from now we should be back to normal, hopefully, and we're projecting a year from now. I think the main thrust of our book was we could do healthcare a lot better than we're doing it now. Right now, and correct me if I'm wrong, about a quarter of Americans either under in short or unasured and they get their healthcare at the emergency room and then they get unforeseen bells and as bankruptcies up the wise. There in fact, I think healthcare bankruptcies are the most common kind of bankruptcy in the United States and you ask yourself, why is it the ways of rich nation have this appalling system? What happens? You know, forty years ago we had a great system. Is going not from profit, Blu Cross, Blue Shield. Everybody was insured. If you want tod fancy your insurance, you could get travelers, but it was or nonprofit. And the problems of happened. I think as the industry has become more profit oriented, particularly in the last thirty years, and most healthcare insurance companies are corporations that have shareholders and want to make profit. I was thinking, why is it that capitalism does not apply to healthcare when it applies to so much else? You know, and I was thinking of the analogy with a motor industry. You take a corporation like Mercedes and they make a product in high demand and the more of that product they ship, the more money they make. So the interests of the CEO, of the shareholders and the customer are all aligned. The customer really wants the product and wants to pay for it, the CEO really wants him they have that product and more products he ships and more money makes.

So everybody's interests are aligned in a sort of Adam smithie and universe. But there's a you said, well, that's obvious, but it's not, because the insurance industry is quite different. It provides a product in high demand, health insurance, healthcare, but the more of that product is ships, the less profit it makes. So it has a perverse disincentive to provide the demanded product. Well, might just to build on what you just said for a moment. The way they analyze the business and insurance companies is they look at how much they spend on healthcare and and that is called the medical loss ratio. In other words, as you were saying, when insurance company pays for care, they look at that as a loss. So I think that really supports your view of the analogy between the auto industry and the difference between that and the private insurance industry. It really is a problem and you know, we as doctors and patients together dealing with ever mounting bureaucracies which are erected in service of this goal of not providing the demanded product. Give you a concrete example. I have a patient with MSS and it's a serious issue and she tells me that after eighteen months, she woke up one morning and when she flexes her head and neck she feels alectrystic going down the spine. Now that means MSS until proven otherwise, and you would like to you're going to give a high dose cortigo steroids, which are serious medications. You'd really like to be quite sure that's exactly what it is. Is Not some this problem something else. And because she told me that the lightning begins at the top of her head, I thought well, we'll save some money. Would just do an MRI of the brain and the cervical spine. Turns out their normal without any they're not normal that there's no change and she now talks well. Actually was between the shoulder blade. So now we have to get a Thoracicamur I...

...scan. It's taken three days and any amount of time on the behalf of my office staff to get this thing done and you know, it's just an a polling situation. I can think of a much better way of handling it that would actually reduce costs, but that's that's another story for a later time. I'm going to too much death, but that that's a concrete example of bureaucratic inefficiencies that arise from a need to lower cost or lower outgoing from the insurance company. Well, Mike gets a very good point because, as you know, the research we did for our book we determined that for a family of for they spend more than a thousand dollars a year without actually spending anything that they know about, on the bureaucracy of healthcare. Fourteen percent of what our nation spends on healthcare is the bureaucracy of the billing and the prior approval and the challenges that you're talking about when compared with other nations. We are much higher in terms of the area of bure accuracy and billing. In Japan the cost is less than three percent, which works out in their system to be under a hundred dollars a year for all of the billing on a per capita basis, which about the same as Medicare, although and Medicare has been used shining the good example of the way things can be done. There is creeping bureaucracy in Medicare, however, and this month, the starting month of two thousand and twenty one, here it comes now. You know, if every eye is not thought it, every t is not cross, a denied payment and they getting rather like the commercial insurance companies, and undoubtedly they're overheads are going to go up and as a result of that, you know, doctors are cheap. Our income is ten percent of the total cost of healthcare. You know, why are you torturing us? And they're much better, more efficient ways of we think, even more efficient than Medicare, but Medicare is generally much better, more efficient than commercial insurance. Well, my understanding is, you know, Mr Biden in his plan would like to go to...

...a public option, and you and I discussed the public option quite a bit in our book about how that could create more competition and lower the cost for individuals and companies. In President, by this plan he would like to make a public option available to anyone to just buy it. But you know, I think there's a little bit more power in that if we require all companies to provide insurance for their employees while at the same time giving them the option to be self insured by public insurance or private insurance. And in saying that, the majority of employees work for large companies. So there's approximately in normal times before the pandemic, about a hundred fifty million people who got their health insurance through employment. That was provided by sixty percent of the companies and remaining ten percent of employees are in small business. That's forty percent of employers. You know, if we were to go to an employer requirement for insurance, as they have in Germany and several other nations, we would have to provide a pathway for small business as much like your business, that would protect them from some of the costs of insurance that they do not currently have. So I think the president should be spending his subsidy that he wants to use to bolster Obama care on small business, as opposed to spending it on individuals, because if everyone gets insurance through their employer, the subsidy requirement would be to make small business strong so that it can grow and become larger, as it as occurs in most small businesses. What are your thoughts about that? You make a good point. You know, it's interesting and again you may know the numbers better than idea, but I think is approximate. If you ask Americans if they approve of Medicare for role, about seventy two percent say yes they do. And then if you ask a follow up question, which is by the way, you do realize this means you too will be required to have Medicare, support drops to thirty six percent. So what we think is...

...going on is when Americans here Medicare for all, they really here universal healthcare, but only a minority of Americans will have it from themselves. Now that could be just because they're not familiar with it, but nevertheless I think Bernie Sanders approach was a vote loser just because only thirty six percent of Americans will have supported it. Well, the choice issue is very important. Like you're right. So what we came up with is, you know, why not have an option? Let's say you have at there and signer and Blue Cross and whatever, and you say, by the way, there's another option, which is the icon and Hutchinson Plan and whatever it is, or some Medicare style plan that is available to all employees. So you don't have to have it. If you don't want to, you can stick with the commercial insurance, but people who do have it will notice perhaps or they get better results and less bureaucracy and gradually over time people will be persuaders giving more competition. So I think this is when we can have all the people who are already insured. You don't want to change their commercial insurance. Their colleagues may get it through Medicare. So it's actually a very simple solution. I don't know why this is taking so much time is proven so difficult. I also find it interesting that if you look at the per capita cost of healthcare in the United States, with all these people uninsured and underinsured, it's still almost twenty percent of per capita GDP. If you look at Switzerland, that has universally acknowledged universal healthcare of a very high standard. Every single one of their citizens is fully ensured and it cost twelve percent of GDP. So what makes America uniquely incompetent that we can't do the same thing? I don't think there's anything, you know. It's just we have a massively bureaucratic system that is in favor of the corporations, where Americans pay three, four five times as much for drugs, where peel pay much higher deductibles and premiums and don't get such a great result. So it would be very easy, I think, to...

...go back to a system such they have in Switzerland or Germany and save a lot of money. So that's where the trillion dollars comes in. It's a difference between twenty percent of GDP and twelve percent of GDP. We think we get down about I think you and and I agree, you get down about thirteen percent of GDP and cover everybody. It's goodness for everybody. The corporations could save up to two hundred and forty billion dollars a year. So another tax break without a tax break. So Republicans should be on board of it. Taxes don't have to go up, so Republicans ought to be on board with it. So you know what's not to like? If you say Medicare for all, they'll sex shouts socialism, and if you say no, the icon on Hunchinds, and that is don't Medicare for all. It's the option of Medicare style plans, which are inherently cheap because they have low overhead. Well, I think you're right. But another important thing that I'd like to share with you to see what you think, is the issue of choice in the Medicare for all world. What will happen is companies will be charged a tax based on their head count that they can't control. So you know in the survey that you pointed out, Americans like Medicare for all until they found out that they might lose choice. And I think employers should have choice as well. They should be able to choose, as I said earlier, the private plan their self, insurance plans or, you know, our plan for the public option. But within the design of our public option there is sort of a safety net for insurance companies. They're going to have to compete with the public option and we know that will be about thirty percent less expensive than their cost. But the plan that we design does not have a Medicare advantage part of it that Medicare has. Medicare advantage cost about thirty percent of the cost of Medicare, and we're saying this is for younger people than the Medicare age group. So we're going to take that away. But insurance companies can...

...design wrap around products similar to Medicare advantage for younger people, which would have a lower costs that employers could buy for their staff or people could buy individually. So it's a new market that insurance companies could compete in. That would maintain viability for those companies that really want to compete and stay in the business. And the reason I think insurance companies would want to do that is ninety percent of their revenue comes from employer based insurance. So if we're going to change that market, that operating envelope, we can also sort of give them a carrot around which they could build business to be a part of the new healthcare market. Right. Remember that fifty percent of their profits come from Medicare advantanced plans through it would allow those to be changed. Sure, and we're not changing Medicare advantage in Medicare. We're just saying that you can develop products to wrap around a public option of the design that we selected in our research. So you think will who would lose in this? If you're going to save a trillion dollars a year, who's going to lose? Well, we think the hospitals will not lose. They're no longer going to be able to charge five hundred dollars for a tylenol or a hundred thousand dollars to pull a little piece of bone out of somebody's back, but they will have to accept reduced rates. Now, on the other hand, they'll be able to shed that massive bureaucracy they have in the basement that's constantly challenging challenges from the Insurance Industry, which is costs hospitals a lot of money. And the second thing is nobody's going to be on in shorter under insure. Right now they are required by law to take care of patients, to shop in the emergency room irrespect of their ability to pay. Everybody will now being should so we think, putting all that together, the hospitals will not do too badly out of this. The main is not getting around this. The main cost savings is going to come from the shedding of bureaucracy, billing, for example, and all the bureaucratic apparatuses of the insurance industry, because they realize they can't afford...

...to keep this bureaucracy going right. Well, another important savings, Mike, is savings for the federal and state government's because under our plan, everyone that is employed that is currently on Medicaid will get insurance to their employer, even if it's subsidized, as we discussed earlier. So that means sixteen percent of the people on Medicaid will now be getting employer based insurance, and that saves the government more than two hundred billion dollars a year. So it's another opportunity for a compromise that provides universal healthcare that Democrats want and generally, historically, Republicans want to reduce the federal budget. So we're providing a vehicle for the federal budget to be reduced and to make the Medicaid rolls a little smaller. And you know, as we continue to discuss this, I think we'd like to see Medicaid actually become just part of Medicare treat people with better healthcare and treat the providers that give them their healthcare with appropriate payment for the services that are needed. So I think there's a lot of opportunities here in the way we approach cost savings for people to actually get the healthcare they want, to have a better access to health care, better compensation for the people that provide healthcare, less bureaucracy and more competition in the insurance market. So I think this is a great place for us to conclude our discussion today and let's go back and discuss it again every month so that we can bring people up to speed on how healthcare can be a right and not a privilege in our society. Well, thanks, Mike. See you next month. Thank you, see you next month. Thank you for taking the time to listen to my coauthor, Dr Mike Hutchinson, and myself discuss some of the important features of the Korn and Hutchinson all care health plan that we describe in detail in our book healing American healthcare. If you'd like to learn more about our health plan how it could save more than a trillion dollars for the United States every year...

...and still provide coverage for every American, check out our book at Amazon, Barnes and noble or at our website, healing American healthcare dot Org. Book is available as a paperback or as an Ebook. So, until next time, stay well, check out our book and we'll be back in about a week.

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