Dr. Lynn Blewett
speaker
80 appearances
1 recordings
1 series
first heard May 2024
last heard May 2024
Dr. Lynn Blewett’s voice in public audio — every appearance, attributed to the second.
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Appearances
Thank you very much.
Well, a lot of times people start with health insurance coverage and that this is like the mechanism to get you in to see a doctor if you have health insurance coverage. And then you, so sometimes when people talk about access to care, they're talking about access to health insurance coverage.
And that's where we spend a lot of time in terms of using survey data and information to understand who's covered and by what type of health insurance and then who's not covered. And that's kind of the vehicle to get access. What you really care about is that people have access to a healthcare provider to get the care that they need.
But usually, you know, I would say most people will start like, do you have health insurance coverage and what kind of health insurance coverage? And then who's in your network and who can you, you know, who do you have access to see when you need care?
Yes.
Yeah, and maybe I'll just preface to say that we have one of the more complicated health care systems in the world.
That most, you know, most countries do provide universal access through different mechanisms. But we have kind of a patchwork of insurance and most people in this country don't. get their health insurance, especially under age 65, get their health insurance through their employer. So about 50% of people get coverage through their employer.
And then you have your kind of supplemental coverage, which is Medicare, Medicaid. And then for those people who are working, but don't have access to employer sponsored insurance. So that could be like artists or self-employed people, or, you know, people who work on their own. They have access to what's called direct purchase.
So that's just if you called up Blue Cross Blue Shield and said, I need a health insurance plan, what do you have to offer? So that's kind of the overview. And then, of course, we have the Veterans Administration's Indian Health Service, the military, TRICARE. And those are also important components, but probably less, not as many people. So-
Yes, I would say the elderly and probably the disabled, the elderly and disabled. And many of those people, especially if they're poor, will be on either Medicare or Medicaid if they're poor. And those are where the high cost, high expense people are. And the public does provide public programs for their needs, Medicare and then Medicaid.
Yeah. Yeah. Thank you for that question, Clarence. And I I missed one important part of our sort of coverage framework, which is there are about 8% of people across the country, which is, let me just check my number, 26 million who don't have health insurance coverage. And so there is what we call a safety net
which provides free or low-cost care, and that's through federal and state funding, so federally qualified health centers or community health centers. We have rural immigrant programs, and then like HCMC, the public hospital, which is funded by state and federal grants and financing. And Medicaid does pay for some of those people in those programs, but they're very community-based, local-driven.
And if you don't have health insurance, you should be able to find one of those and get either low-cost or no-cost care. Many of them don't provide access to specialist care, but they may be able to help you find somebody who would be willing to take somebody at a discount.
Well, you know, I like to, I don't like to use the term single payer because it, it polarizes people.
Single payer means, you know, government run, government sponsored health care. And there are some models. So, you know, England has a universal care program with public, funded by public dollars, and most of the health system is publicly supported. But there are also other systems where there's a combination of public and private entities.
And so I like to refer to universal care and different ways to get to universal coverage or 100% coverage. There's different ways to get there. And I, you know, I, it's so hard to, I'm 100% supportive of universal coverage. And I think the United States could get there. But
in this political environment and for the political environment we've had for many years now, it's just a huge roadblock to get there. So I'm 100% supportive. I was 100% supportive of Bernie Sanders, who was advocating for Medicare for all. I think there's different ways to get there. One thing I do I do kind of come back to is the states that have tried, single payer have done studies.
So Vermont was kind of, states have advanced this and Minnesota kind of goes and fits and starts on a model of universal coverage. And Vermont was a state that went kind of ahead of all the other states. And the problem was, is that transferring private funded healthcare services to a public funded system requires an increase in taxes.
And so when people see that explicit tax amount that costs are, you know, that would be needed to fund our healthcare system, right now our employers, so 50% of people get their insurance through employers. We call that private insurance, right?
But they get a subsidy on that, on what they contribute to. There's a huge subsidy transfer to them, but we don't see it. It's like implicit. So even though we're, you know, it's tax supported in many, many ways, we don't think of it as tax supported. So as soon as you make that explicit and say, okay, private sector, you're not responsible for healthcare anymore.
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