Why We Need a Universal Healthcare System

As some asshole with a blog has mentioned many times, we need a universal healthcare system. Forget for a moment the discussion we had during the presidential primary season about exactly what that system would look like and WHO WILL PAY FOR IT?!? Having been around and in public health and infectious disease for many moons, it is obvious that we need a universal healthcare system–not necessarily a universal health insurance system (we’ll return to that in a bit). This is prompted by something Jen Gunter recently wrote on the Twitter machine:

If we had a unified healthcare system*, we would have the possibility of being able to track not only influenza-negative ICU admissions, but things like reported COVID-19 symptoms, even if testing hadn’t been available (and a national patient identifier would prevent ‘double reporting’–someone whose doctor reports symptoms, and then checks into the hospital wouldn’t be counted twice). And state by state differences in reporting wouldn’t be an issue either.

It would not be trivial to build this on the fly, but it could be done in a universal system. Right now, we have no way of tracking these data. There would be, at least, the potential to do that tracking. But in our balkanized healthcare system (and that’s an insult to the Balkans), we just can’t, expect in a few places, where consolidation has led to some private systems that could pull these data semi-regionally. We also have multiple reporting system and LIMS, and there’s no easy way to report or get these data–if at all.

Realistically, in the U.S., the only political program with the heft to build such a system is the Medicare-for-All movement. Despite pundits like Bill Scher arguing otherwise, none of the other options have the potential to get us there (and, please, the ACA tried, and utterly, utterly failed. Just don’t with that). Sure, a handful of economists can engage in fantasy discussions about a hybrid Japanese-Dutch decaf system with a lemon twist, but, within the context of U.S. politics and existing legislative infrastructure, Medicare**-for-All is the only way to get to this unified system.

*Arguably, an administration that built a unified healthcare system also would have had a much better public health response, so this might have been redundant. Better redundant though, than dead.

**Though the Medicare-for-All proposals actually resemble Medicaid for All much more.

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2 Responses to Why We Need a Universal Healthcare System

  1. EMD says:

    CMS (the Centers for Medicare & Medicaid Services) could do this for the 2/3 or so Medicare beneficiaries who are not in Medicare Advantage using the Common Working File that its contractors (the health insurance companies to whom CMS contracts a bunch of claims processing work) update daily based on claim submissions. Well, for payment reasons teaching hospitals submit claim-like records even for Medicare Advantage patients.

    Because of the lag between discharge and claim submission (because of coding translations from medical records to claims) can be 1-3 weeks. But, in the very least such data could be used to corroborate other COVID-19 ICU and other discharge rates, at least for a large number of elderly and for a good chunk of permanently disabled individuals. Sure, younger non-disabled would be missed, but at least for this disease one should have been able to identify where hotspots

    I should have said “could have been corroborating”. No technical reason why they couldn’t have started tracking this in January. Again, with a lag, but at least it could have helped tune models of where problems are happening.

    And, to be honest, even if any Medicare/Medicaid for All were passed today, it’d be quite a while before nationally we could get below a 2-3 week lag, I’d expect. Not at all advocating against any flavor of M4A, just trying to both be realistic but also identify what sort of things administratively would be good to get on as quickly as possible.

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