The American electorate is in the mood for significant change. Let’s start with our fragmented, expensive, underperforming, frustrating healthcare system. We have by far the most expensive healthcare system in the world, but are way down the list when it comes to health outcomes.

In the Dec. 20 issue of The Week magazine, journalist John Semley of the Toronto Star sums up some of the problems with America’s healthcare system like this: “I moved to the U.S. a few years ago, and I…have encountered its byzantine, baffling, and maddening health-care system. As a Canadian raised on our national single-payer system, I’d never even taken my debit card to the doctor’s office. I was blissfully unaware of stuff like medical co-pays, premiums, exclusions, and deductibles. And I’d never had to pore over a list of different plans, with varying costs during an open-enrollment window, wondering how sick or injured I could afford to get in the coming year…Canadians should take this moment (recent killing of a United Health Care CEO) to appreciate what we have:  a health system that binds the social fabric. When everyone gets the same excellent care, equality of all citizens is enshrined.”

Today’s column offers some ideas for improving our healthcare system:

1. Universal coverage: We are the richest country in the world, but the only developed country that views healthcare as a privilege rather than a right. While Obamacare provided insurance coverage for more people, millions are still uninsured or underinsured, contributing to bankruptcies, unnecessary suffering, and needless deaths. Many U.S. physicians belong to Physicians for a National Health Program, which advocated for Improved Medicare For All — a universal single payer system like Canada’s.

Medicare was established under President Lyndon Johnson, in 1965, as a government program for seniors 65 and older, and for younger citizens with certain disabilities. Medicare’s overhead is around 1.4%, whereas private insurer’s’ administrative costs are 12-18%. It’s estimated that switching from our current system to a single payer system would save around $500 billion a year.

• Eliminate medical insurance companies: They add to the cost and complexity of healthcare, and don’t serve a purpose other than making money for their CEOs and investors. Many of the employees in hospitals and physician offices are there just deal with private insurance companies, which impacts their overhead.
• Develop a true health care system instead of a disease management system: In writing about our healthcare system, it’s impossible to ignore the primary cause of preventable disease and death:  unhealthy food. Instead of a healthcare system, we have a disease management system:  rather than preventing diseases—which is always the most cost-effective option–we wait until they occur, and then spend trillions of dollars trying to manage them. Eighty percent of the chronic diseases Americans suffer and die from would be prevented if people just ate more fruit, vegetables, whole grains, nuts, and seeds; and moved about more. This would result in a commensurate decrease in the healthcare expenditures. Currently, medical students learn little to nothing about nutrition or prevention—which needs to change.
• Control big pharma: Americans spend $650 billion a year on pharmaceuticals–$5,000 per family. The Biden administration capped the price of several drugs, including insulin, but this needs to expand. Furthermore, pharmaceutical companies currently have biased and undue influence on most medical studies. 
• Big supplement: Americans spend huge amounts on supplements, which are largely unregulated, often contain impurities, frequently don’t have in them what the label says, and in most cases haven’t been proven to work. Supplements need to be brought under FDA control.  
• Change physician payments:  Medical school should be free. Many students finish medical school with $200,000 debts, which encourages them to go into high-paying specialties, instead of primary care. Physicians should be paid a salary, as is the practice at the Mayo Clinic and Kaiser Permanente. Fee for service encourages excessive expensive procedures and practices. Physician payment is currently weighted towards procedures, whereas preventive care offers more value to the system.
• Stand up to big food:  We can’t dictate what people eat, but strategies such as sugar taxes work. Our government should stop subsidizing foods that cause disease and start subsidizing health-promoting food (where’s Big Broccoli when we need it). National food guidelines should be established by scientists, without political influence.

The original intent when Medicare was established in 1965 was that it would be expanded to cover everyone over the coming years. We are way overdue; the time has come.

Dr. Greg Feinsinger is a retired family physician who started the non-profit Center For Prevention and Treatment of Disease Through Nutrition. For questions or to schedule a free consultation about nutrition or heart attack prevention contact him at gfeinsinger@comcast.net or 970-379-5718.