The state of U.S. health care is a timeless debate often marred by political leanings. However, convoluted offerings and restrictive availability simply can’t exist in a world ravaged by a lethal pandemic. The solution comes in the form of a streamlined approach via the well-known Medicare Advantage Program. Says longtime health care professional Dr. Mehmet Oz and former Kaiser Permanente CEO Mr. George Halvorson, this is an efficient and understandable way to provide Americans with universal health coverage.
The Need for Change
Dr. Oz and Halvorson are very clear in their belief that the need for change has never been more pressing. As it stands, health care has always favored those with money. Less wealthy Americans (many of whom are minorities), have faced inadequate health care options for years. Now, with the emergence of COVID-19, this inadequacy is exacerbated.
A large number of hospitals employ a fee-for-service model when serving patients. This, in conjunction with other strains across health care, is what has broken the system for decades. Fee-for-service models typically demand large out-of-pocket costs for patients, and with COVID-19, it’s projected that many of these fee-for-service hospitals and medical groups will face serious financial dilemmas in the coming months.
It’s easy to understand why. Because these hospitals depend upon upfront payments, a dip in patient numbers results in a dip in earnings. The COVID-19 pandemic has sent the United States economy into a severe flux; patients with fee-for-service plans can’t afford the formidable charges that they must pay even to see a doctor. Given the technology that we have available to us, the health care system should be flourishing. Instead, Americans are denied basic services because their medical plans don’t cover them, or worse, they don’t seek out these services because they have no plan to cover them.
In a way, COVID-19 has acted as the schoolteacher that you don’t want to listen to but know is right. We need to fix health care across the country, and we can’t spend years debating what changes to make or letting politics steer the discussion. Health care change needs to come in the form of empathy and resilience. Americans need and deserve plans that make them feel safe, while health care facilities deserve a system that keeps them strong, especially in times of crisis.
Dr. Oz and Halvorson’s proposal lies with the Medicare Advantage Program. Those already using Medicaid – a program designed to tackle medical costs for people with limited income – can keep their plans. But for those without Medicaid, the proposal calls for buying health care coverage through the Medicare Advantage Program and buying coverage for every American who doesn’t currently benefit from Medicaid.
Here’s the thinking behind this: A 20 percent payroll tax can be used to buy this health care coverage. Since most employers already spend close to that amount to provide employee benefits, there isn’t much of a loss in doing this. Approximately half of this payroll tax would be covered by employers, which means that Americans would pay only 10 percent of their income for complete health care coverage. For many, this option would be astronomically better than what they currently have available to them.
Dr. Oz and Halvorson will be the first to tell you that their plan isn’t groundbreaking. In fact, it comes from looking outward and studying health care beyond the borders of the United States. A large percentage of Western European countries have been employing this health care strategy for a while now. They use payroll taxes to foster true, existing funds that are then allocated toward health care programs.
Many of these programs are similar to Medicare Advantage, which only requires a monthly premium paid by the beneficiary for both inpatient and outpatient coverage. With this type of structure in place, no citizen has to worry about being on a cheap, government-dispersed plan that covers next to nothing and leaves them grasping for cash in the midst of a national crisis.
The key is intentionality. A 20 percent payroll tax is intentional toward the goal of providing health care to all. It’s collected and stored as an account separate from other governmental finances and used only for what it was meant to be used for: universal health care coverage.
Why Medicare Advantage?
There’s been a popular argument before about extending basic Medicare coverage to all Americans. However, this fails to account for the complexity of such a maneuver. Because the government doesn’t have a direct hand in dispensing Medicare coverage, doing so would require a complete overhaul of infrastructure and logistics. It would also still require a piece-by-piece purchasing approach, which is what we want to stay away from moving forward.
On the other hand, the Medicare Advantage Program already has structure in place. It has working relationships with a vast network of care providers, replete with negotiated payments and the ability to expand its offerings as more and more Americans join the program.
More importantly, Medicare Advantage comes with better benefits. There’s plenty of quality control across the program, and its cash-flow model is designed to allow for continuous improvement. In directing Americans to Medicare Advantage, the government would simply pay a monthly fee to private insurance companies for each insured patient.
Revisiting the Benefits
The benefits of such a drastic shift in American health care speak for themselves:
- A 20 percent payroll tax would be split between employer and employee. In many instances, this would be less money than an employer already spends on sponsored health insurance.
- Medicare Advantage would give each person coverage with only a $1,000 deductible and, because the plans themselves would be paid to health care providers in monthly installments, there wouldn’t have to be a reliance on fee-for-service models any longer.
- While a striking amount of health care costs currently come from chronic diseases, Medicare Advantage plans are financially beneficial when these diseases are controlled. There’s also a benefit in reducing the number of congestive heart failure cases (whereas other plans make money from the hospitalization that comes with this), so those on Medicare Advantage plans have witnessed a drop in heart attacks due to the services provided.
- Without buying health care piece-by-piece, the Medicare Advantage model encourages quality health care all the time. Fraud is also expunged because payments are made monthly instead of per service.
- Using the Medicare Advantage model has the ability to reduce the country’s administrative costs because of the removal of a piece-by-piece purchasing system.
- Medicare Advantage plans are already in place and being used by Americans, which means that the transition to universal coverage via Medicare Advantage is completely doable.
Introducing Medical Advantage
With their proposal laid out on the table, Dr. Oz and Halvorson have coined it “Medical Advantage.” The benefits are clear and, given the crisis that has seized hold of the world, there is no better time for the United States to reevaluate its health care. Both professionals feel that if we were to institute a program like Medical Advantage, we’d look back a few years from now and wonder what took so long. While the program might serve as an immediate response to a crisis, its long-term advantages can’t be ignored.
About Dr. Mehmet Oz and George Halvorson
Dr. Mehmet Oz is a practicing heart surgeon, television personality, radio host, and author. Dr. Oz decided early in his life that he wanted to be a doctor after seeing the work that his father did as a surgeon at Wilmington Medical Center. He graduated from Harvard University and then earned an MBA from The Wharton School and an MD from the University of Pennsylvania School of Medicine.
Dr. Oz’s career has been very unique. He’s a talented surgeon with particular skill in heart transplants and minimally invasive procedures. After treating a patient whose family forbade a blood transfusion for religious reasons, Dr. Oz changed his perspective on medicine and sought natural treatments to fuse with traditional Western practices.
Dr. Oz is the founder of the Cardiovascular Institute and Integrative Medicine Program at NewYork-Presbyterian Hospital and co-author of “Healing from the Heart: A Leading Surgeon Combines Eastern and Western Traditions to Create the Medicine of the Future,” which he wrote with his wife. His real claim to fame, though, came as a recurring guest on “The Oprah Winfrey Show.” Since then, he’s gone on to make several television appearances and host his own show, “The Dr. Oz Show,” which has been on air since 2009.
George Halvorson is a graduate of Concordia College, and he also completed graduate work at the University of Minnesota and the University of St. Thomas. Halvorson has spent his career as a health care executive, most notably serving as chairman and CEO of Kaiser Permanente from 2002 to 2014. Prior to this, he served as CEO of HealthPartners in Minnesota for 17 years.
Halvorson has published nine books on health care reform, including “Health Care Co-Ops in Uganda.” He has also completed four books about human social interactions. Since 2012, he’s served as the chair and CEO of InterGroup Understanding, an institution committed to working on problems surrounding racism, prejudice, discrimination, and stress and conflict. In 2015, Halvorson received the IMPACT Visionary Award from AdAge.