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to every American , financial data could be expunged from health care data and therefore , identity theft and the criminal motivation to hack hospital / clinic computers would be reduced . Responsible sharing of patient data among various hospitals , labs and clinics in a manner compliant with the Health Insurance Portability and Accountability Act would occur . There would be no reason to repeat an imaging or laboratory test on patients when they are transferred between institutions . Comparison of prior and current imaging and laboratory data could be made in a timely fashion .
The initial cost of creating a patient databank would be hefty and all health care entities would have to agree to upload their patient data to compliant data centers . This is akin to how the National Security Agency maintains sensitive data in the Utah Data Center , also known as the Intelligence Community Comprehensive National Cybersecurity Initiative data center . The primary difference between the civilian patient health data and the national security data system is that the former data farm would be responsibly transparent to its stakeholders while the latter would , by necessity , remain opaque .
I think that the absence of transparency and lack of connectivity between the different systems and processes in health care is where significant cost savings are lost . Specifically , the cost to the system is the work-around to compensate for the inefficiency that must happen to connect one part of the health care system to another . An example is the purchase of any pharmaceutical to treat a patient . Pharmacy benefits managers determine which drugs and at what price each drug can be administered to a patient . 2 These middlemen have significant impact on patient care , and they are rewarded for raising their profit margins . And for their profession to exist , there must be significant information asymmetry in the system – not to mention the ongoing daily onslaught of odious forms for every treating physician .
A lack of transparency lowers the trust which citizens have with health care corporations as well as their government . This causes a natural pushback whenever a new health care reform is attempted . There are certainly many health care providers who feel that any government control of health care would result in lower wages to the providers . It would be germane to point out that , in 2010 , at the time of the Affordable Care Act , physicians were paid only 10 % of overall health care spending ! 3 This means that cutting all income to physicians would do virtually nothing to lower health care costs except that nobody could afford to practice medicine .
One way to build trust would be to have a bipartisan approach to a single payer system . Consultation will always win over dogmatic debate and ego ! The Canadian system earned trust slowly by using a bipartisan approach and started in Saskatchewan just after the second world . It wasn ’ t until the mid-1970s when all 10 provinces and two territories had established a single payor system which resulted in “ free ” health care for all Canadians . Medication and dental coverage are covered by out-of-pocket insurance . The system is now so popular that any political party opposing the single payer Medicare system would be voted out of office .
In the opinion of the author of this paper , the major challenge of single payer systems is that it addresses demand side economics only , while ignoring supply side economics . For example , when you make patient visits free , you increase physician utilization . At the same time , you ignore physician capacity for that utilization . The same phenomenon happens when employed physicians are told to see more and more patients for the same income . In the beginning , doctors will spend more time at work to care for patients . At some point , they get burned out . Eventually , patient time with physicians is lessened , resulting in superficial treatment of disease while lowering time for root cause analysis of patient care . Eventually , a single payer system will result in less time thinking ! Therefore , a single payer system cannot survive as a standalone payment in any country unless it can meet the demands of all its stakeholders .
One way to have a sustainable system is to lower supply side demands , such as by having a copay for all patients except the abject poor . This is different than the Canadian system , as doctors in Canada are not legally allowed to accept copays . Copays lower the number of patients that are seeing a physician for “ social ” reasons . Lowering administrative fees would benefit supply side demands by diminishing the amount of time doctors spend coding and charting . In the end , more time could be spent with patients .
It is the opinion of this author that large health insurance companies behave like governments in that they control health care by regulating what is paid for , thereby curbing physician autonomy . Any notion that a multi payer system is more in keeping with capitalism than a single payer system is misguided . If insurance premiums are considered a form of tax expense , then insurance companies collect more from premiums than Medicare does in taxes . At the time of this writing , Medicare pays 80 % of the fee schedule amount for services rendered . 4
Ironically , if America wants a single payer system that is accessible to all , without patient care delays , some of the monies given to health insurance companies will have to go to Medicare . For this to happen , the citizenry would need greater trust in the system – the solution would have to be apolitical . The alternative is that the country pays more money to insurance companies acting as a middleman with resultant larger and larger hospital systems mired in bureaucracy and leveraging their time and money to negotiating to collect higher fees from insurance companies . Perhaps if those
36 LOUISVILLE MEDICINE OPINION