The health of Americans has changed significantly in the past 25 years that I have been practicing in medical school/university hospitals, as well as the private sector.
Poor nutrition and overeating have raised the average weight of Americans by 20%–35%. In addition, people are becoming overweight at a much younger age. This raises the risk of heart disease, hypertension, diabetes, and chronic illnesses in a younger population. When coupled with cigarette smoking in the United States, it is no wonder why health insurance premiums have soared over the past many years.
As the United States now spends close to 17% of the GNP (all dollars spent per year) on healthcare, we are in a crisis that must be addressed. The proposals range from keeping healthcare in the private insurance domain to raising the percentage of Americans obtaining healthcare from government funds, in a model similar to Medicare and Medicaid. The current healthcare programs funded by the government are already two trillion dollars in debt.
Changes in our system must occur to reduce costs, but this should not happen by moving to a government-owned single payer plan. This type of plan will not be as efficient or possess the quality of most private carriers. Not to mention the fact that physicians, especially specialists, will decrease in number across the country due to the government's strict regulations regarding specialist care.
I would recommend the following changes be made:
Divide the uninsurable population into risk categories. These risk categories would include age, prior medical problems, and exposure history (smoking etc.). People that are more likely to cost more for the insurance company to care for should be equally divided among the private healthcare insurance carriers (including Medicare) in all 50 states. These people will likely have to pay more of a premium depending on their health status. No one should be denied health insurance, especially due to a pre-existing condition.
Uninsured people not eligible for Medicaid or Medicare should be given financial assistance by the government based on their employment status and other financial factors.
The use of emergency care in all hospital systems needs revision. Patients who have minor illnesses need to be referred to step-down care facilities similar to a family doctor/minor care unit. This will reduce costs immediately as one ER visit can cost between $400–$1000.