Thoughts on Healthcare for All

The main argument against universal healthcare in the US is that the government will ration the availability and limit the extent (i.e., no experimental or “heroic” care for the desperately ill) of healthcare to control costs. This seems to hold up in comparing the U.S.’s mainly private system to Canada and most EU countries. Notwithstanding this dynamic, it is clear the universal healthcare has become a public good similar to policing, roads and firefighting; the country suffers along with the un-insured under the hidden costs of lost productivity, un-paid medical bills and bankruptcies driven by costly medical bills. There is a psychological cost too — the untold misery of those living with chronically bad health that must choose between care and paying for basic necessities. There must be a better way.

Following are some brainstorm ideas for improving the health of all Americans and providing universal healthcare with reasonable quality and extent:

• Health Education: Require that all schools teach the value of good nutrition and exercise, using updated guidelines that are not influenced by processed food conglomerates (the food-industrial complex has its tentacles deep into Washington). Include warnings on processed food of the dangers of over-consumption — similar to the highly successful anti-tobacco campaign of past decades.
• Eliminate Food Deserts: Per calorie, processed food is way cheaper than farm-fresh food. And, it is distressing to see the poor quality of produce in supermarkets in lower-income neighborhoods. Use subsidies and tax credits to encourage high quality and affordable produce and meat in lower-income neighborhoods. Put special emphasis on high quality organic produce and sponsor farmers’ markets particularly in under-served areas.
• Tax Fast Food: Include a meaningful tax surcharge on fast food: 25% or so. The taxes go toward eliminating food deserts. Provide incentives for developing and providing menu items with acceptably nutritious foods.
• Start the US Medical Corps: Focusing on the disadvantaged, provide a free-of-charge medical education for all levels of healthcare professionals. In exchange for free tuition, graduate nurses, doctors, therapists, etc. would agree to work in under-served locations for a reasonable “payback” time period.
• Medical Office Building Tax Credits: Provide generous tax credits for medical office buildings that serve disadvantaged neighborhoods.
• Increase Taxes on Alcohol and Tobacco. Alcohol and tobacco are responsible for a great portion of illness and social problems, particularly in disadvantaged areas. Eliminate loopholes for cheap alcohol aimed at chronic abusers.
• Create Walkable Neighborhoods: Invest in traffic calming and streetscapes that encourage walking and help support small business services. Pay for the investment through surtaxes on sales of new vehicles with poor fuel economy.
• Control Prescription Costs: Allow more competition for common, basic drugs (e.g., insulin) and set maximum prices; the much lower cost of basic drugs in other countries shows that the market will accept controls. Subsidize development of experimental drugs in exchange for reduced unit costs upon introduction.
• Health Dividend: Provide a meaningful cash rebate for individuals that complete routine healthcare screenings, with bonuses for maintaining healthy biometrics. Encourage good health without shaming bad health per se.
• End of Life Care: Leaving the option to the patient and their family, educate on the value of palliative care to extend quality of life rather than excessive, but ineffective curative care. This is a tough issue, but the patient deserves to know their options.

Providing good healthcare to all must be a top priority for our country moving ahead. The problem is, however, multi-faceted and requires a comprehensive approach focused on wellness first and equitable access for all. Measures must be crafted to prevent reduction in healthcare supply through unnecessary bureaucracy and arbitrary cost controls.