Many people voicing support for universal healthcare think it is some form of magic bullet that would be adopted and implemented in a single day and all problems would be resolved.
None of this is true. In fact, it would and should be adopted gradually over years to overcome the difficulties that would be encountered on many levels.
Supplemental insurance. This is a key sticking point for many people. I have pointed out that Tulsi Gabbard openly states her plan would include supplemental insurance, while Bernie Sanders admits his plan would as well but only under coerced admittance. Now, consider the fact that nearly every country that has universal healthcare also has supplemental insurance. If we moved to universal healthcare, think what would happen the day it was announced, if no supplemental insurance were included. That very day, the stock market would crash. Medical claims would be denied, even if previously approved. Tens of thousands, perhaps hundreds of thousands of Americans would lose their jobs. Doctors offices, clinics, hospitals and pharmacies would be forced to close their doors within weeks. Not out of greed. Out of necessity. That would suspend or eliminate hundreds of thousands of other jobs. From there, downstream spending would plummet, causing more complications.
Of course, these effects could be very slightly dampened by legislation mandating companies to keep their doors open, insurance companies to honor claims, etc. That does not keep investors from selling off stocks, cashing in bonds.
By allowing for supplemental insurance, many jobs would be maintained. Investors would still pull funding but not completely.
Timeline. There would have to be a plan which included a specific timeline which phased in the introduction. This could take many forms, such as introducing specific existing medical conditions by target dates and culminating in universal coverage.
Job creation. I have pointed out previously that universal healthcare would absolutely create more jobs than it eliminated. Meaning living wage jobs. However, this process would not be instantaneous. One crucial aspect would be funding the expansion of medical professional training. This could take the form of federal funding or even federal training programs for each state for various medical professions, especially nursing, nurse practitioners, licensed physician assistants (not to be confused with medical assistants), etc. This training takes years. Even as hospitals across the country have been closing at a rate of 35 per year, the nursing shortage has continued. Universal healthcare would make that situation far worse and spread the problem to other medical fields.
Waiting times. You can definitely count on wait times for medical appointments of all kinds to be temporarily extended. The implementation of universal healthcare should include new systems which require less direct interaction with providers for basic care. Telephone and internet consultation systems have been developed which help with this and could be adapted to such a new system. Those would have to be expanded. The current systems are for profit and if they choose to not take part in the new system, they would have to be replaced with government run systems. Self referral for some specialties should also be an option with prior approval.
Medical criteria. While Medicare/Medicaid has a strong set of medical criteria already in place, it is insufficient to cover the needs which would be required under universal healthcare. The criteria currently in place cover existing conditions and less preventative care. Some of the criteria needed could be derived from insurance companies but would still require review, rewriting and implementation to incorporate into the system. Once again, this is a process which would take years to accomplish fully.
Billing and payment. While universal healthcare would simplify medical billing, the specific systems necessary for the scale of the system would have to be not only expanded and updated but more systems put in place to reduce fraud, waste and abuse. Funding would be a challenge in the beginning, as there would absolutely be a massive surge of claims by those who may have foregone medical care for years. After 2–3 years it would decrease and level off but there would be numerous adaptations to even figure out the right balance between cost to taxpayers and payments to providers. During that time there would be a lot of bitching and moaning about how unfair the system was, it was a bad idea, etc. Nothing of this scale happens without some kinks to work out.
Contracts and logistics. Medical facilities and offices have contracts with providers of services, equipment and medications. In many cases, these are dictated by insurance plans. Many of these contracts will have to be renegotiated, which again takes time. Of course, if all service/equipment/pharmacies are obligated to accept referrals from any provider, this will simplify things. However, don’t count on this happening right away because of everything detailed above.
Quality of care. Even if we solve the problems of training medical professionals, that does not insure quality of care. With a system which would be burdened by a new large number of patients, I would expect some decrease in quality of care for a time, until we achieve a strong enough density of medical professionals to weed out the weakest links. I’ve seen horrible incompetency in my years in nursing. Just last week I had to explain to another nurse that DNR means Do Not Resuscitate, it does not mean Do Not Treat. Then I had to explain the difference. If we had a mad rush to graduate a mass number of licensed people, chances are quality of education, testing and oversight would be decreased as well if more oversight is not included in the new system, which would also take time. Oversight would have to be done concurrently with the phasing in of the new system.
None of this means that we should not be pushing for universal healthcare. We absolutely MUST push for it. Medical care should not be available only for the wealthy. It should be considered a human right above and beyond profit motives.
My entire point is that just passing legislation is not going to solve all our problems in a single shot. Changing our entire system will take time. It is a huge and complicated task, not just a change in paperwork. It affects all of our lives, not just a few. There are aspects of this that some who have an unearned sense of privilege will obviously object to. Others will object because they want to move instantaneously to a state run system with no option for supplemental insurance. While an eventual move to a truly universal system may be possible, even that seems unlikely. There should be supplemental insurance for things like cosmetic care, which the rest of us should not have to pay for. I’m certain that insurance companies would be able to devise special insurance plans for that purpose, if they do not already exist.