by Peter Rogers
I have experienced health insurance and health care in the United Kingdom, Canada and the USA, and like many others I continue to be frustrated by the fact that in the United States of America, we lack Universal Medical Insurance (sometimes erroneously referred to as “Health Care”).
Born in West Wycombe in the UK in the late 1930s, I was raised and educated there during WWII and the Post-War years, receiving a Ph.D. in 1963. I grew up as a beneficiary of the National Health Service (NHS). The NHS was founded in 1948, and is the largest UNIVERSAL, SINGLE PAYOR Medical Insurance entity in the world. Even though both our children were born at home, at NO TIME did I ever feel that medical care was unaffordable or unavailable.
In 1967 I moved to Canada with two small children, lived in the Province of Ontario and received health insurance through the Ontario Health Insurance Plan. OHIP was established in 1966, and was a predecessor of Federal/Provincial UNIVERSAL medical insurance program established in Canada in 1972. As in the UK, in Canada I never felt that medical care was unaffordable or unavailable, and all career decisions were made WITHOUT reference to employer offered medical insurance or the portability of such insurance.
When I moved to the USA in 1973, I was appalled to discover that certain professions were licensed & regulated at the state level. It seemed to me that in a country that prizes upward social and economic mobility, which is facilitated by geographic mobility, it was an anachronism and impediment that driver’s licenses, lawyers, doctors and all forms of insurance should be licensed and regulated at the state level. This cumbersome, decentralized licensing and regulatory approach, with its various power centers and inefficiencies, has inhibited our ability to develop a portable, UNIVERSAL Medical Insurance Program. That said, the dysfunction and inefficiency of the USA insurance market had no affect on me or mine before I retired, because throughout my academic and business career my employers always provided medical insurance for us all.
The key issue facing millions of Americans who are individually employed, entrepreneurs, between jobs, or just live in difficult circumstances, is the absence of portable UNIVERSAL coverage. For many, this means that medical care is unaffordable, unavailable, or unobtainable when people get really sick. Our economy is based on free movement of goods, services and labor, and we need a rational national solution to health insurance to facilitate this.
Personally, I favor a Single Payor Solution where economies of scale should reduce inefficiencies and result in improved care. I have experienced the economic benefits and efficiencies of such systems in the UK and Canada. Why can not Medicare, a FEDERAL Single Payor program, – be extended to cover all US citizens? Once such a system is implemented, economies of scale, including implementation of automated record-keeping, etc., should result in a reduction of costs AND improved care.
As a person on Social Security, I participate in Medicare. With supplemental insurance, out-of-pocket costs for myself & my wife annually total $12,460. Although high, these costs are far less than the amounts required by ACA from what I read in the press, if one considers premiums, deductibles & co-pays required under ACA. Under our Supplemental AND Concierge Fees we pay very little in co-pay with no deductibles.
Here are the costs:
Peter Medicare Premium: $1,332
Peter Supplemental: $3,142
Doreen Medicare Premium: $1,608
Doreen, – Supplemental $1,970
Prescription Insurance: $408
Concierge Doctor*: $4,000.00
Some of these expenses merit an explanation. As Medicare reimbursements are low, some doctors refuse to treat Medicare patients, so that in order to receive the services of our doctor of some thirty years, we pay an “Access Fee” of $4,000. Our doctor’s scale of fees is: $2,600 for adult individual, $4,000 for adult couple, $500 child under 25. My wife uses no prescription drugs, but the “system” requires that she purchase prescription drug insurance. I take only the “standard” statin and Flomax, – a prophylactic prostrate medication. Obviously these premium expenses are a snapshot, and will increase with time. Also, they are much higher than we would pay out-of-pocket as we are both healthy, (considering our age, that is!!); but that’s what insurance is all about, – one hopes that one will never have to use it, but it’s there and affordable when the need arises.
My point is that there are reasonable, effective, proven solutions out there. We could look to the UK, Canada, Europe or Japan for such solutions… or we could just look at the model for the Medicare program.
The issue is not an absence of good solutions to medical insurance. It is an absence of will on the part of well insured politicians, whose campaign wheels are greased by insurance companies.
Peter Rogers’ career spans the academic, business and nonprofit worlds, including as CEO or President of eleven companies/divisions ranging in sales from $65 million to $8 billion with up to 65,000 employees. He has served on diverse nonprofit and business boards, focuses on literacy and poverty issues in his nonprofit work, and lives in downtown Chicago with his wife Doreen.
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