Economist, doctor suggest publicly funded health care as solution to insurance woes

By Sean Kirkby, Wisconsin Health Journalism Fellowship

Publicly funded health care could fix the country's ailing insurance system, an economist and a physician agreed during a Health Journalism 2024 panel.

Amy Finkelstein, an economics professor at the Massachusetts Institute of Technology, said that 1 in 10 Americans under 65 are uninsured at any point and a quarter have been without coverage some time over a two-year period.

Finkelstein, who co-authored the book "We've Got You Covered: Rebooting American Health Care," with Liran Einav, an economics professor at Stanford University, said the U.S. health care system isn't the result of design. Instead, it has been "layered on, patch after patch," with solutions put in place, for instance, to ensure access to care for those with certain medical conditions and who are lower income.

That approach has left gaps where people don't qualify for programs due to eligibility limits or have to navigate complex systems to stay covered. Even those with insurance can be exposed to unaffordable medical expenses, with three-fifths of medical debt held by people with coverage.

However, those who are uninsured still receive care, for example, through public programs for safety-net hospitals, nonprofit hospitals that receive tax subsidies in return for providing care to those who are low income and community health centers that are backed with public dollars.

"It's a cobbled together patchwork … that doesn't work well," Finkelstein said.

Finkelstein called for establishing a health system that is "automatic, free and basic," but allows those who are able to supplement their coverage.

The nation can afford it, given that it spends 18% of its gross domestic product (GDP) on health care, about double that of other countries, she said. Half of what the U.S. spends goes to taxpayer-financed health care too.

"We're already paying as taxpayers for automatic universal basic coverage," Finkelstein said. "We're just not getting it."

Ricardo Nuila, an associate professor of medicine at Baylor College of Medicine, works at Ben Taub Hospital, a county hospital in Houston funded by property taxes. He wrote "The People's Hospital: Hope and Peril in American Medicine" about the hospital and its patients.

Nuila was born into a family of doctors and struggled with deciding to pursue medicine as a career after seeing how his father, a physician, became burned out by the health care system. His dad, an OB-GYN, started in private practice in the 1980s with a nurse and receptionist. By the time Nulia was applying to medical school, his father had hired more employees, including three dedicated full-time to dealing with insurance claims.

"I said, 'It's too transactional. Everything about health care in America is about money. I don't think I can be a doctor,'" he said.

He ended up pursuing the profession anyway and trained at the hospital, a rarity in the health care system due to its public nature.

"Public health care, I think, is a real solution that we need to think about in forming a new health care system," Nuila said.

Sean Kirkby is senior editor at Wisconsin Health News. He is a 2024 Wisconsin Health Journalism Fellow.