Super glad you asked because I've been waiting for an opportunity to talk about health policy (or really anything that isn't COVID19). First, I think it's helpful to understand where we are now. 1/ https://twitter.com/Rapidvtach/status/1264278122989588487

The US already spends more per capital on healthcare than any nation; almost double the average of comparable countries, all of which (besides the US) have some sort of universal coverage. Looking at JUST government spending only 3 countries spend more than us. 2/

Despite that, we have poorer health outcomes by many metrics compared to similarly wealthy nations in areas like infant mortality and life expectancy. 3/

So where is all that money going? One answer is that our fractured system creates a lot of waste - tests re-ordered because different EMR's at different institutions don't talk to one another. We also have to hire TEAMS of people to deal with billing and insurance bureaucracy 4/

We also are the only developed country that doesn't exert any price controls on prescription medications. In fact, in the United States it is ILLEGAL for Medicare to negotiate drug prices with drug companies. 5/

But another big answer is the for-profit insurance industry.
Americans pay in to the system for their insurance. The company then pays some of that money back for their care. The rest of it they get to keep to give to their shareholders as dividends 6/ https://www.fiercehealthcare.com/payer/big-name-payers-earned-35-7-billion-2019-here-s-one-common-thread-their-reports

And also their CEO's. Just to be clear: shareholders and CEO's of Insurance companies are making enormous profits off the labor of physicians and the suffering of patients. They consider money they pay us to care for patients "medical loss" 7/

That being said, we have also decided as a society that we sort of believe people have a right to healthcare when push comes to shove. That is why Medicare exists, because we don't believe our elderly should be left out somewhere to die when they get sick. 8/

We also have EMTALA, a law that requires emergency rooms to treat anyone who comes in with a medical emergency or in active labor regardless of their ability to pay. So we have decided to some extent that are aren't okay with people just dying in the street. 9/

And most people have no idea how vulnerable they are - even with "good" insurance - to having a medical event devastate them financially. They also don't realize the extent to which their insurance company will dictate the type, location, cost, and timing of their care. 10/

On the physician side, I spend hours of my own time every week responding to insurance company denials, changes in medication formulary, and other demands that delay care to my patients, waste my time, and sometimes result in them not receiving the care they should 11/

Don't tell me that government bureaucracy is worse: the majority of my patients are covered by the government programs medicare and medicaid, and they are infinitely easier to navigate. Sometimes it's actually HARDER to get care for my insured patients than uninsured 12/

So currently we have managed to create the most expensive and inefficient healthcare system on earth. It does not serve patients or physicians. Being able to "choose" your insurance so they can dictate who you see and what care your receive is not meaningful choice 13/

So to the question of who would pay for universal health care in the US - we all would of course. But we already pay an equivalent amount of money to what other nations pay for their universal systems, without having one. 14/

Obviously there would be taxes involved. But for many Americans those taxes would simply be in place of what they ALREADY pay for their medical care, and provide them with GENUINE choice of where and from whom to get their care as well as real financial security 15/

The proposal I personally support was written by my fellow physicians and is essentially an expansion of medicare. The legislation has been previously introduced and can be read here: https://www.congress.gov/bill/115th-congress/house-bill/676/text 16/

It would create a single-payer system based on Medicare in which all US residents have free choice of their doctor and hospital and physicians and health care entities are reimbursed promptly for necessary care. It would also mandate the creation of a national EMR 17/

There are, of course, many ways other nations have solved the issue of access to medical care for their citizens and this isn't the only model. 18/

As for the issue of wait times, no government "determines" wait times. Wait times are a factor of capacity. We do have a capacity issue in our country, particularly for certain types of care in certain geographic areas. However, this issue requires a different solution 19/

Do I think this system will be perfect and solve every problem? Of course not. But I do believe it would be a vast improvement. And of course there will have to be some parameters around what is covered and what criteria must be met. All systems have that. 20/

To those worried about government making rules about healthcare: our elected officials are accountable to us. And under this system, they would have the same insurance. For-profit companies are accountable to their shareholders. So I will take my chances with the government 21/

Do I think changing our entire system will be easy? Of course not. It will be difficult and painful. There will be flaws to work out. But as anyone who has made it through medical training can attest, just because something is difficult doesn't mean it's not worth doing. 22/

Bottom line: I believe American patients and doctors deserve better. I will continue to advocate for that. Fin.