Featuring Dr. Philip Verhoef, Clinical Professor of Medicine at the University of Hawaii and ICU physician: Why was there such an uneven distribution of testing capacity in the United States and how can we address that problem in the future? How does bureaucracy impact American health care? In this third of a podcast series, Dr. Philip Verhoef joins host Brenda Gazzar to explore how pooling resources and minimizing bureaucracy with Medicare for All could save lives. Plus, what are the downsides to Medicare for All?
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Pandemic: How Pooling Resources & Cutting Bureaucracy Can Save Lives
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Welcome to Code WACK!, your podcast on America’s broken healthcare system and how Medicare for All could help. I’m your host Brenda Gazzar. Today, we’ll talk to an intensive care unit doctor about the ways Medicare for All could benefit us in a pandemic.
Dr. Philip Verhoef is a clinical assistant professor of medicine at the University of Hawaii and an ICU physician and immunology researcher in Honolulu. He cares for critically ill children and adults and has cared for COVID patients during the current pandemic.
This is the third episode in a series with Dr. Verhoef about the deadly coronavirus.
Welcome to Code WACK!, Dr. Verhoef.
Verhoef: Thanks, it’s a pleasure to be here.
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So testing early on was something that the United States didn’t do on a massive scale. Would Medicare-for-All help in that regard with early comprehensive testing?
Verhoef: I think the biggest help that a Medicare-for-All system would have would be that it has the government’s purchasing power, the government’s resources. You know, what we’re finding is that certain jurisdictions have more capacity to test more than others. You know some hospitals are developing their own tests and that’s because they have the resources to do that, and so the ability to scale-up testing literally depends on having the resources to do that. And so if you have a starved local health department, there’s only so much that they’re going to be able to do. On the other hand, if you have a large hospital system that can put some resources into developing their own tests and scaling it up, you can see perfectly well how this could be done effectively and so in my mind, if you had the resources pooled under the federal government’s national health insurance system, it becomes so much easier to say ‘oh, let’s take 10 million of this 500 billion dollar enterprise or whatever it is and upscale rapid lab development.’ This is not something that’s hard to do — certainly not something that’s hard to do for most of the NIH-funded researchers out there. I have been an NIH-funded researcher myself and the process of actually developing a test is fairly straightforward. There’s a quality control approach that needs to happen but it’s not like the government wouldn’t be able to scale that up with the people that already get government funding as it is. So one can easily imagine that if you have the resources of the federal government, you could scale up the development of testing if you wanted to.
Some people may worry that having a single-payer system like Medicare-for-all could slow things down because you’re dealing with a large bureaucracy. What are your thoughts on that?
Verhoef: I think that is a frequent concern that people have and I think the devil is in the details in how you construct a single-payer system. So if you look at our current healthcare system now, the bureaucracy is gargantuan, right? I’ve heard a number that says that every doctor needs two-and-a-half administrators just to deal with insurance companies on average. That’s how many more administrators there are than doctors. If you create a markedly simplified system where everybody is covered, everybody gets the same plan, you no longer have to hire administrators to deal with claims denial or reimbursement requests or the hundred different healthcare plans that you may deal with. You suddenly have actually a much smaller bureaucracy than we currently have and so I think it’s a reasonable point to say ‘gosh, a big single-payer would be a big, bureaucratic beast’ but honestly, Medicare as it currently stands, runs really really leanly, right? Ninety-eight cents out of every dollar that’s paid into Medicare gets used to pay for hospital care and not for administrative expenses. It’s actually the private insurance system that we have now that imposes a tremendously large bureaucracy on us.
Got it. Do you have any concerns or potential concerns about Medicare for All in terms of fighting a pandemic or otherwise?
Verhoef: Well, that’s an interesting question. I’ve never thought about that. You know, I’ve been a Medicare-for-All advocate and I can think of all the ways that Medicare-for-all is helpful and I think it is possible for a well-designed Medicare for All system to handle this pandemic better than the system we currently have and I think we’ve seen that in some of the other countries that have universal healthcare systems like Taiwan or South Korea, where they’re really able to manage these pandemics really well.
If I had to imagine what the downsides would be, it’s sort of like saying what are the advantages of the current system that we have now that we would lose under Medicare for all? I’m just not sure that I see any. I mean we’re protecting people from bankruptcy. We’re protecting people from avoiding care because they’re afraid of being stuck with the bill. We are basically arguing that everybody should get a high level of care funneled through a single system. I frankly don’t see a lot of downsides to that, especially because nobody’s saying that we can’t integrate private enterprise into this, right? If we are in the position of a pandemic, why not have the government’s subcontract to a pharmaceutical company and say ‘hey can you upscale this lab test? Can you upscale this drug? Can you do this testing?’ It’s not like we’re saying we’re going to completely shut private industry out of everything. We’re going to look for the best ways to solve the problem. We can just do it with a much bigger pocketbook if it’s the federal government than we can if it’s individual states or a smaller jurisdiction.
Thank you so much, Dr. Verhoef. Find more Code WACK! Episodes on ProgressiveVoices.com and on the PV app. You can also listen at HEAL dash C-A dot org. This podcast is powered by HEAL California, which uplifts the voices of those fighting for healthcare reform around the country. I’m Brenda Gazzar.
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