Might the U.S. have improved its COVID-19 vaccination roll-out by having a Medicare-for-all single-payer system in place?
The simple answer is, You betcha!
The three main problems with the United States vaccination effort are lack of centralized control, fragmented delivery systems, and non-interoperable data systems for tracking. Local healthcare monopolies can be “free-lancers,” operating willy-nilly as they wish. They can also operate independently of each other, without much local coordination. And, to make matters worse, their computer systems often cannot even “talk” to each other.
Medicare-for-all single-payer would overcome all three problems.
Medicare can use its financial leverage to command and control of services and processes. It can do this by setting Conditions of Participation and by enforcing performance standards. No compliance, no payment.
Medicare can provide financial incentives to coordinate care among various providers and systems, and can penalize failure to coordinate care.
Lastly, Medicare can set data standards – what data is collected, how it is stored, how it is transmitted for payment purposes, and interoperability standards. Even if two different hospitals had two different electronic health record systems, so long as their data was compatible, their data could easily be shared.
Theoretically, Medicare could leverage centralized control, coordination among systems, and uniform data standards, even now, since it already finances forty percent of healthcare spending. However, it does not have the constituency to overcome the political clout of the healthcare sector.
However, if Medicare-for-all were implemented, its constituency would be the entire public. Even the large army of K Street healthcare lobbyists would be no match!
Countries that have national health delivery systems — not just financing systems — are proving to have the speediest and most efficient vaccination roll-outs. Think Israel, United Arab Emirates and United Kingdom.
Inefficient, slow vaccination roll-out is a vivid example of the havoc in our fragmented healthcare non-system. In fact, fragmentation of care is the single largest driver of waste throughout the whole healthcare system. Administrative inefficiency accounts for $265 billion of waste annually, according to a 2019 study in the AMA Journal, reviewed in a previous post.
The Trump Administration apparently made little effort to overcome the fragmentation in our healthcare system. Nor did the Administration activate FEMA’s Incident Command System. Thus, the Administration achieved only 16.5 million shots-in-arms before leaving office. The new Biden administration is taking steps to mobilize a “wartime effort” to work around the fragmentation in order to get 100 million shots-in-arms within the first 100 days.
All well and good. But what then about the rest of the sick healthcare system?
Take Action
Now, take action!
Image Credit
Title: Daily Covid Vaccination Doses per Capita
By: Our World in Data, University of Oxford
Permission: All of Our World in Data charts, maps, and text are licensed under a very permissive ‘Creative Commons’ (CC) license: The CC-BY license. The BY stands for ‘by attribution’ and this means you are free to take whatever is useful for your work. You just need to provide credit to Our World in Data and our underlying sources
Fixing U.S. Healthcare 