Why America Needs to Open All Healthcare Channels

6 min readJun 30, 2020

Part XIII: Yes, Now is the Perfect Time to Talk Healthcare in America

Note: This post is one part of my series, Yes, Now is the Perfect Time to Talk Healthcare in America, which provides an in-depth look at the current healthcare system so that it can be reformed. Click the link or scroll to the bottom to check out the other posts in the series.

I firmly believe that America’s healthcare system can be made better. Healthcare impacts every citizen and aids our wellness, happiness, productivity, and success. It’s every bit a family issue, as it is a financial issue, and a lifestyle issue. Healthcare hits home for so many and has dominated political discourse for decades.

The COVID-19 pandemic did not launch it into prominence but has elevated its importance to heights hardly fathomable just a few months ago. It has commanded the nation’s attention, and we owe it more than a fleeting moment. In order to improve the system, I now offer a few of my own recommendations focused on improving accessibility, affordability, and equality.

A Path Toward Universal Insurance

I believe that we need to commit to universal healthcare and offer a path to every citizen. Before the pandemic, about 8.5% of Americans did not have any health insurance, and in my view, this is unacceptable. No other democracy leaves a segment of their citizenry uncovered. Yes, any American can buy health insurance, but it’s not affordable for far too many. At the same time, as the pandemic has underscored, people who lose their jobs often lose their health insurance along with it and, can suddenly be left bare. As discussed in an earlier post, people can still buy into COBRA, but this remains a short-term safety net and can be too expensive unto itself.

Still, a majority of Americans receive their health insurance through employment and don’t want to see their coverage suddenly upended. To this end, I recommend that additional government health insurance be extended to those who have no coverage and offered as a health insurance plan by employers. However, I don’t subscribe that Medicare is the only government instrument.

The Federal government operates numerous health programs with insurance pathways like FEHB, CHIP, and TRICARE. To me, these programs can become a conduit to health insurance for the greater population. They can still focus on those in their respective chartered missions, like federal employees, vulnerable children, and the military, but can be opened up to offer basic insurance to the general public too. If many health insurance plans already exist and operate well, why not use them?

Why Other Strategies Won’t Work

As witnessed through the Affordable Care Act, the startup process to create and roll out individual marketplaces and new state healthcare plans was chaotic and disjointed, and it only extended to 20 million Americans. Imagine increasing the scope by 16x through one program like Medicare.

Any sort of migration to one program would take years. I see no evidence that it has the widespread public or political support to withstand the requisite years of fits and starts. It’s pretty unimaginable that Congress would commit to the kind of consistent and long-term funding to properly operate something of this magnitude.

Additionally, to meet the needs of those who already have employer insurance, the program would need to scale rapidly. The majority of America, which already has employer-based insurance, would need to exit to a new, fully-operational form of coverage. America’s bureaucratic nature doesn’t seem like it would quickly and continuously coalesce to build this health insurance apparatus. Not only does the idea lack broad popularity, but it also currently garners fervent rejection by a large number of Americans.

Conversely, private health insurers have no incentive to close the remaining gap. The vast majority of the uninsured American population is low-income, unemployed, or young. Among each of these subgroups, health insurers stand almost nothing to gain. This strategy, along with ceding all responsibility to the states, won’t solve the problem.

For decades, America has slowly inched toward expanding government health insurance. It has targeted these subgroups while private insurance has hardly moved a muscle. Since these subgroups do not offer lucrative returns, and in many instances losses, they don’t entice the market.

Meanwhile, the states which do not support universal coverage at the federal level have often fought the same fights in their respective legislatures too. Even on a smaller scale, these state governments balk at appropriating the needed funding. To me, this argument rings hollow because it’s actually a tested hypothesis and hasn’t worked.

Net Benefits of a Multi-Channel Approach

The fastest route to universal coverage is neither housing all Americans under one insurance program like Medicare, nor is it through the free market. Instead, universal coverage can be achieved most expediently through building on the existing system and restructuring through a targeted, centralized approach: provide federal government coverage for all who don’t have it and allow employers to offer it too. However, with this approach, Medicare will be the largest tool but not the only one. In tandem, it will exist with all other government health insurance plans.

In the short run, closing the coverage gap will be expensive but necessary. I believe that America can blunt the cost curve and potentially offset the impact with a heavy, simultaneous injection of low-risk.

Initially, the government should specifically focus to entice young and healthy Americans who currently have employer-based insurance to switch. These programs can offer a substantial, lifetime discount. We see this with the aforementioned German and Australian models. They incentivize young people, who are statistically lower risk, to enroll in government health insurance. In return, the government sees a strong return on investment; costs wane over time. This diversified approach stymies the influx of higher risk and in the long run, costs can be more easily driven down.

With more people under a self-elected government health insurance plan, the government’s purchasing power increases. In concert, these varied health insurance programs like Medicare, FEHB, CHIP, and TRICARE, offer choice to citizens, dilute risk through spread, and create collective leverage.

As a whole, the federal government will have more ability to negotiate drug prices and medical costs and more naturally drive down prices. This strategy would be more economically viable than price fixing. At the same time, if they want to compete, private sector insurers will have to get competitive. Otherwise, more employed citizens will exit to a government-based plan. Perhaps, this will spur them to to reduce excess administrative costs, offer more robust coverage, and ultimately create better, universal healthcare.

Thanks for reading! If you enjoyed this post please clap, share, and feel free to add me on LinkedIn to share any feedback. For links to all of the other blog posts included in this series, see below.

1. Yes, Now is the Perfect Time to Talk Healthcare in America

2. The History of Pre-1970s Healthcare

3. The History of Modern Healthcare

4. What is Medicare?

5. The Debate Around the Affordable Care Act

6. Three Areas Where the American Healthcare System Actually Works

7. Three Areas Where the American Healthcare System Fails

8. The Driving Forces Behind America’s Healthcare Cost Problem

9. Voter Attitudes Surrounding Healthcare

10. How the United States Can Fix Healthcare, According to the Presidential Candidates

11. International Healthcare Systems: Western Democracies

12. International Healthcare Systems: Eastern Democracies