Popular support for a single-payer health system has waxed and waned, but currently hovers around 56% versus 38% in opposition. That makes Medicare for All a popular political idea.
It’s why many Democratic candidates for president support it. But candidates are far from consensus on what Medicare for All would look like.
Their disagreements illustrate how contentious and time-consuming any political solution to our country’s health care crisis will be.
Radical solutions are popular
Heartbreaking stories about the high cost and low value of health care are everywhere. On a macro level, one in four patients skipped treatment last year because of the cost and patients borrowed $88 billion last year to pay for health care.
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In the abstract, the single-payer solution promises to make health care more accessible. But it won’t necessarily make health care better or more affordable. The Congressional Budget Office says costs to taxpayers for any such program would be astronomical and whether it would improve health will take years to determine.
What works now
By contrast on-site and near-site employer-based clinics are a proven concept for improving the quality and affordability of care. Centered on primary care, the model disrupts health care from the inside, thwarting the perverse incentives that sometimes bankrupt patients and cause them to skip needed care.
Unlike Medicare for All, this model needs neither presidential support nor a law passed by Congress.
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Employers, or coalitions of employers, can choose to implement these clinics, which provide convenient primary care close to work or home. Workers and their dependents get same-day access to health care providers at no cost. They also receive many prescription drugs and some lab work at no cost. Best of all, providers spend as much time with patients as they need, with most regular visits lasting 20-30 minutes so they can address immediate and chronic health conditions and personal health goals. Often, these clinics provide access to nutritionists and other ancillary services, again at no cost, to help patients manage or improve their health.
The result is lower costs and better health. For example, at South Bend Community School Corp. in Indiana, 71% of patients who presented with hypertension reduced their blood pressure to normal levels or by a notable amount, and population-level measures of cholesterol, diabetes management and weight management all show significant improvement.
Growth is accelerating
One-third of U.S. employers with 5,000 or more workers now offer on-site and near-site health clinics, up from 17% in 2007. Such clinics are showing strong growth among employers with 500 to 4,999 employees, too, with 16% currently providing a medical clinic for employees and another 8% considering adding one in 2019.
One reason for the growth is the potential ROI—up to $1.50 for every dollar invested. South Bend Community School Corp. has achieved a cumulative ROI of $1.60 from its clinic in the five years since its inception.
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Changing the health care system makes for a lively political debate. But affordable, quality primary care is the key to getting the outcomes we want. The best on-site and near-site health clinics improve health, reduce total healthcare costs by 10-25% and provide an exceptional benefit for employees and their family members.
Someone should tell the politicians.
Debra Geihsler, principal at Activate Healthcare, previously served as CEO and president of Harvard Vanguard Medical Group and Atrius Health System in Boston. Prior to that role, Debra served as CEO of Advocate Medical Group, where she led the creation of various employer-based on-site clinics.