Viewing entries tagged
Healthcare System
California, Massachusetts, New Jersey, Rhode Island, Vermont, and Washington, D.C., already have insurance mandates. Residents in these areas must have qualifying health coverage or face tax penalties. Except for New Jersey, their uninsured populations are lower than the U.S. rate of 7.9%. For instance, the uninsured rate is just 2.8% in Massachusetts and 3% in Washington D.C. That’s not too far from universal coverage.
A universal healthcare system can be established in the U.S. by leveraging existing structures like Medicare, Medicaid, and the insurance industry, using a range of provider and consumer incentives to control costs. The old and disabled would continue to receive Medicare and government support would be available for low-income households.
Here are components of the existing system that would be retained, expanded or tweaked in my proposed universal healthcare system…
Should the U.S. have a universal healthcare system? By all means! No American should be denied necessary care. Besides, according to the latest Pew survey, 66% of Americans want a universal system, the younger the stronger the support. Even Republicans are getting on the universal healthcare bandwagon - 41% in the latest poll, up from 32% in 2021 (Pew Research, 2025). The time has come to get serious about what such a system should look like in the U.S.
Per capita healthcare spending in the U.S. was over $15,000 in 2024. That’s around 2,5 times the OECD average for member countries and most of those countries provide universal care. U.S. healthcare spending is projected to grow faster than inflation over the next several years, reaching over $24,00 per capita by 2033, or roughly 20% of GDP. This is an untenable situation, especially if we want universal healthcare, which would require coverage for another 25 million Americans. We obviously need to come up with a less costly healthcare system that performs well and serves all Americans. Here are some ideas on what that system would look like, bare bones version…
Based on statements submitted by 1,225 health insurers, the National Association of Insurance Commissioners (NAIC) reported the health insurance industry experienced a significant decline in both net income and profit margin in 2024. The net income dropped to $9 billion, a sharp decrease from $25 billion in 2023 and the profit margin fell to 0.8%, down from 2.2%.
What the American Medical Association says: “Nurse Practitioners are essential members of the physician-led care team, but they are plainly not trained to practice independently.” What researchers have found: “Public safety is often used as an argument against expanding scope of practice (SOP) for nurse practitioners, despite the benefit of filling unmet health care demand…[We found] absolutely no evidence that states that expanded scope of practice performed worse than states that chose not to in terms of public safety.” Bhai & Mitchell, 2025
As documented in the last post, the AMA gives “three big reasons” for opposing independent nurse practitioners (NPs):
It won’t solve the rural access problem.
It will raise health care costs, not cut them.
It threatens patient safety.
I tackled the rural access issue in the last post. This time I will address the second reason the AMA gives for opposing independent NPs.
According to its website, the mission of the American Medical Association (AMA) is to “promote the art and science of medicine and the betterment of public health.” The AMA is also a lobbying organization that promotes the self-interest of its members: physicians and medical students. But sometimes the greater good does not mesh with the self-interest of physicians. And sometimes the AMA puts self-interest first.
I’m more interested in the salary gap between physicians and the average worker. As it turns out, that gap is also bigger in the US than in Canada, France and Germany. And yet Americans see their doctors less often than the Canadians, French and Germans. In fact, the bigger the salary gap, the fewer doctor visits per capita…
One reason the federal government spends so much on Medicare and Medicaid (M&M) is that the entire US healthcare system is expensive, no matter who pays the bills. The providers and suppliers are pretty much the same, whether the payer is private or public. Sure, the feds have some pricing power, but squeeze too hard and healthcare service providers will simply say thanks but no thanks.
The Centers for Medicare and Medicaid Services estimates that up to 25% of health care spending in the United States pays for low-value services, defined as unnecessary or ineffective procedures, tests, scans, and medications. A recent study estimates that in 2022, 71 per 100 Medicare beneficiaries received low-value services. In 2023, Medicare and Medicaid spending reached $1.9 trillion. Reduce that by 10%…
For comparison, as of 9/30/24, the Dow Jones average net profit margin was 2.46%; the Nasdaq average net profit margin was 16.09%. And according to a January 2024 analysis by NYU Stern School of Business, the average net profit margin for US corporations across 94 industries was 8.54%, based on a sample of 6481 firms.
The authors don’t tell us why Medicare and insurers are increasingly relying on prior authorization, nor do they address the prevalence of unnecessary or low-value medical care or the risks associated with such care. That’s a huge omission. Potential harms should be weighed against potential benefits, the better to find solutions that preserve benefits while reducing harm. As for the prevalence and risk of unnecessary and low-value care, evidence suggests that up to one-fifth of healthcare spending is wasted on such care and around 10% of patients are harmed in the process.
Around a quarter of healthcare spending in the US is wasted, much of it on unnecessary or low-value tests and procedures that do not improve patient outcomes. Here are a few ways countries and healthcare systems are tackling the problem…
What this data tells me is that one reason healthcare spending is out of control in the US is that the cost of healthcare services isn’t being borne by the ultimate consumer - patients - but by third parties, mainly insurers, employers, and the federal government. And these third parties are less sensitive to price than individuals and households (for various reasons, including ability to pay, lack of market power, and an artificial shortage of healthcare providers).
Kamala Harris has pledged to increase taxes on the wealthy should she be elected president. Per the Kiplinger Newsletter, she would bring back the top 39.6% income tax rate for people making $400,000 or more, as well as hike the 3.8% net investment income surtax to 5% for these taxpayers. She also plans to increase the long-term capital gains tax rate for the wealthy.
Should Kamala Harris’s election and tax plans come to fruition, US physicians would take a major tax hit. Why? Because they’re rich.
“During the COVID-19 pandemic, Sweden was among the few countries that did not enforce strict lockdown measures but instead relied more on voluntary and sustainable mitigation recommendations. While supported by the majority of Swedes, this approach faced rapid and continuous criticism. Unfortunately, the respectful debate centered around scientific evidence often gave way to mudslinging. However, the available data on excess all-cause mortality rates indicate that Sweden experienced fewer deaths per population unit during the pandemic (2020–2022) than most high-income countries and was comparable to neighboring Nordic countries through the pandemic. An open, objective scientific dialogue is essential for learning and preparing for future outbreaks.” - The Swedish COVID-19 approach: a scientific dialogue on mitigation policies, Björkman et al, 2023
“The graying of America means that the portion of people who are of prime working age is getting smaller, with fewer workers available to fill open positions, ultimately reducing productivity, straining the federal budget, and slowing economic growth.” – Antonioli, J., & Malde, J. (2023)
The Biden administration has proposed some cuts in Medicare spending…But these savings amount to just $24 billion a year over the next decade: clearly inadequate, considering that Medicare spending is projected to increase an average of nearly $100 billion a year over the same period. What else can be done to rein in those costs?
Per the Kaiser Family Foundation: In 2021, Medicare spending comprised 13% of the federal budget and 21% of national health care spending. Medicare spending per person has also grown, increasing from $5,800 to $15,700 between 2000 and 2022 – or 4.6% average annual growth over the 22-year period. Looking to the future, net Medicare outlays are projected to increase from $744 billion in 2022 to nearly $1.7 trillion in 2033, due to growth in the Medicare population and increases in health care costs. Where is all that money going?