Posted by Bill Sandweg on 31 July 2023.

Maybe you remember the old television advertisement in which the auto mechanic told the audience that they could pay him now to install a new oil filter or they could pay him later when their car broke down due to dirty oil.  That ad hasn’t been on television for over 40 years now but the concept is applicable to the debate about how we should pay for healthcare.

Regular readers of this blog know that the United States is the only nation in the industrialized world that does not have universal health care.  The reasons are rooted in our history and the way health insurance developed during the wage control years of World War II.  Although those controls are long gone, while they existed, they fostered the creation of large, very profitable health insurance companies that do not want to lose the money they receive selling health insurance.  As a result, our current expensive and inefficient system of paying for health care is very resistant to change.

The inefficiencies of our system weigh heavily upon us.  We spend more per capita for health care than any of the other industrialized countries but get less for it.  Our outcomes on important health measures are terrible, despite what we pay.  Among the industrialized nations we have the lowest life expectancy at birth, the highest maternal and fetal mortality, extremely high rates of obesity and among the highest suicide rates.  We also have the highest percentage of people with multiple, chronic health issues.

We already provide health care to the poorest among us.  Occasionally, we see some politicians advocate for universal health care.  Their proposals usually do not get far.  On the other hand, there are many politicians who oppose measures to expand health care for the poor.  For example, despite the federal government providing for an expansion of Medicaid eligibility and willing to pay most of the cost, the legislatures of many states have been unwilling to take advantage, even though it would greatly improve the health of their citizens.  The residents of some states with reluctant legislatures have taken matters into their own hands and passed initiatives to force their state to expand Medicaid.

We require hospitals with emergency departments to provide emergency care to anyone who shows up at the door, regardless of their ability to pay.  Only after the emergency condition has been stabilized and it is safe to transfer the patient may a hospital transfer or discharge a patient who has no insurance and no ability to pay.

The hospitals and doctors who are required to provide emergency care to the destitute have to get paid somehow.  Hospitals with poor patients will usually see if they can get the patients enrolled in Medicaid (AHCCCS here in Arizona) and get paid that way.  But if patients are not eligible for Medicaid, the hospital and doctors must absorb the cost of the treatment.  That cost gets passed on to the rest of us in the form of higher hospital and doctor bills.    This where “Pay me now or pay me later” comes into play.

If we are going to have to pay for the cost of medical treatment for the poor once their health care issue has become a medical emergency, doesn’t it make sense to address that health care issue before it becomes a medical emergency when it will almost certainly be cheaper to treat?  Not only will it be cheaper to treat but, by preventing the onset of a medical emergency, society saves money by keeping those patients who are employed actively on the job.  Even if the patient is not working, they may have family members who are.  Having a family member in the hospital with a medical emergency disrupts all of the usual family arrangements and also contributes to lost time from work among family members.

We are so far behind the rest of the world that there is a lot of low-hanging fruit that can be harvested to get us improved health care outcomes without great additional expense.  What we need are people and politicians who will look at practical realities rather than simply adhere to ideological talking points.  We need people and politicians who, when asked if they want to pay $1 for health care now or $2 later, will choose the responsible option.