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If Healthcare Is a Human Right, How Do We Get There?

Allison Inserro
If healthcare is a human right, how do you pay for it in the United States so that no one is left behind? In a session called “Single-Payer Healthcare: Is It the Right Approach for the US?” at the  2018 National Health Policy Conference of America’s Health Insurance Plans in Washington, DC, a panel tried to come up with an answer to that question.
 
If healthcare is a human right, how do you pay for it in the United States so that no one is left behind?

In a session called “Single-Payer Healthcare: Is It the Right Approach for the US?” at the  2018 National Health Policy Conference of America’s Health Insurance Plans in Washington, DC, a panel tried to come up with an answer to that question, as well as others; but first, a leading proponent of a single-payer system laid out a premise for the audience.   

In the view of Donald M. Berwick, MD, MPP, president emeritus and senior fellow, Institute for Healthcare Improvement, healthcare policies and payment designs should be driven by purpose. However, the former CMS chief called healthcare “massively defective—it cannot achieve better care for individuals and populations at lower cost.”

In his view, there are 4 improvements that have to happen:
  • Reduce non–value-added cost
  • Create proof of patient safety
  • Rebalance delivery of care so that it is home-based, community-based, prevention-oriented, and incorporates social determinants of health
  • Embrace innovations like telehealth
“We are treating effects of American healthcare instead of causes," he said to this third point.

Even without being fully implemented, the Affordable Care Act (ACA) was a major step forward to achieving some of those improvements, he said. But he added that our current healthcare payment system is “toxic,” citing fee-for-service arrangements.

He then issued a challenge to the audience: “Is your primary purpose to make healthcare a human right in this country, and to assure the continual improvement of care?”

“I don’t think it is,” he went on, citing what he called one of the clearest bellwethers—the medical loss ratio (MLR)—which he illustrated by noting his efforts to describe it to colleagues in other countries, who find the MLR “insane.”

The conversation around single payer has picked up since last year, when Senator Bernie Sanders, I-Vermont, released his “Medicare for All” plan, and last month, the left-leaning think tank Center for American Progress released a version called “Medicare Extra for All.”

In his opinion, Berwick envisions a public utility structure “an arm’s length” from the government but suggested to the audience, “if I were you, I’d try to define it as Medicare Advantage.”
 
Berwick asked the audience to think about whether or not they think healthcare is a universal right and does it continually improve the care of individuals and populations. “If you don't believe that, then you're not in the right business.”



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