Episode 5: Thinking About U.S. Health Reform

Stacey and Jake are joined by Professor Bill Hsiao.

After listening to Episode 5: Thinking About U.S. Health Reform, we hope listeners are able to make sense of the U.S. Health reform debate. This episode focuses on how listeners can learn to evaluate health systems and what to consider when choosing to support or oppose policies. We will also discuss the social values and ethics behind establishing Single Payer systems, and listeners will hear what goals countries debate and choose to create their Single Payer health systems.

A summary of Episode 5: Thinking About U.S. Health Reform and additional learnings can be found down below.

Thank you for joining us!

Our Guest

William Hsiao Ph.D.

K.T. Li Research Professor of Economics

Department of Health Policy and Management

Department of Global Health and Population

William Hsiao is the K.T. Li Research Professor of Economics in Department of Health Policy and Management and Department of Global Health and Population, at Harvard T.H. Chan School of Public Health. He received his Ph.D. in Economics from Harvard University. He is also a fully qualified actuary with extensive experience in private and social insurance. Dr. Hsiao’s health economic and policy research program spans across developed and less developed nations.

He is a leading global expert in universal health insurance, which he has studied for more than forty years. He has been actively engaged in designing health system reforms and universal health insurance programs for many countries, including the USA, Taiwan, China, Colombia, Poland, Vietnam, Hong Kong, Sweden, Cyprus, Uganda and most recently for Malaysia and South Africa. He also designed a single payer universal insurance model for the state of Vermont which intended to serve as a vanguard for the USA. Vermont passed a law based on his recommendations. However, the recent set-back in Vermont’s economic development has put the implementation of the single-payer system in question.

To learn more about Professor William Hsiao, please visit the Harvard T.H. Chan Department of Health Policy and Management Faculty page.

Summary

There are many reasons why countries have chosen to adopt Single Payer systems - each includes universality of coverage, and some go further to place value on quality of care, non-medical costs, and whether to ensure or not ensure equal access. Australia, for example, uses a two-tier system that provides a universal basic plan to all citizens but allows affluent Australians to opt-out to purchase private insurance. This private insurance may provide greater comfort, convenience, or more expensive amenities that go beyond basic coverage.

Just like Australia had a conversation before establishing their Single Payer system, Bill believes the U.S. needs to have a conversation about the social value of healthcare and the ethical principles that could define the system. The U.S. has not debated the value of healthcare and Health as basic necessities for well-being. If health is determined to be a necessary part of survival and well-being, then similar to the Education system where all students receive 12 years of education, we need to decide what necessary services and coverage must be established.

Who can lead such a conversation? All of us, but a political leader who is brave enough to engage the discourse is required to set a direction.

As with most largescale reforms, there are many questions to ask and beliefs that underly our choices. For example, the libertarian and egalitarian approaches to healthcare may not be absolute? An egalitarian may argue to limit the types of services covered based on cost or vanity, while a libertarian might move to expand services based on an intimate experience with the healthcare system.

Questions include: What is the noble vision or goal set forth by the leader; what specific policies need to be adopted for the vision to come to fruition; what level of financing and what type of financing structure is required, and what types of services are and are not covered? There are all questions that must be asked and debated because it will force individuals to discuss the sacrifices they are willing to make.

There many important aspects of Single Payer systems:

1) Each Single Payer system is unique and their structure and goals depends on the social value people place on healthcare and health and the ethical frameworks they decide to use to govern the system.

2) In order to achieve full cost savings and containment, a uniform clinical and claim records system must be adopted nationwide. Currently, the U.S. has hundreds if not thousands of different versions that make interoperability and data sharing difficult for providers and patients. After identifying a platform or building one, the implementation process could take 5-10 years and billions of dollars. For example, large hospital systems have spent billions of dollars to implement their own clinical records systems. Examples include Epic and Cerner and many others.

3) Single Payer does not deny free choice but that the marketing and advertising from the healthcare industry tell half-truths, thus creating fear among Americans. It is important to note that a Single Payer system leaves the choice of doctor and hospital to the patient.

Lastly, Bill shares that the U.S. Healthcare system is wasting 30% of its spending on non-medical care services - in other words, we are not getting the value for what they pay. While universal coverage is on the mind of Americans, the cost of healthcare and the rate of inflation has largely been left out of the conversation yet Bill argues both will make the current system unsustainable. He also points out that if the U.S. does not adopt a discourse of healthcare reform now, then when the system hits a true crisis, the U.S. may have to make emergency decisions. The decisions could lead to mistakes that have drastic consequences.