Our overall healthcare problems can be summarized as follows: (1) the rising costs are due to increasingly expensive tests, procedures, and therapies that are being utilized in every area, all of which are promoted as beneficial. (2) The increased complexities of the practice of medicine has driven doctors away from the management, putting business people in control of the system, whose job is to make money for whatever office or entity they control. Unfortunately, (3) none of these things has much to do with the overall health of our population, because our culture – how we live, what we eat, what we do – has much more to do with it than expensive tests, procedures, and therapies.
No legislation – regardless of how beneficial it appears – has in any way addressed these issues, and much has actually made things worse. The complexities that have driven doctors away from the driver’s seat have increased exponentially in recent years. Any funding in any area to this system only provides incentive to go after that money; increasing the insurance coverage of people puts more incentive into the system without changing the way it is working.
Look around: beautiful hospitals advertise state of the art care; new outpatient offices and procedure centers streamline access and convenience; revolutionary medicines are advertised on TV; billboards lure the sick by digitally showing the current and short wait time at a nearby ER. Though all of these things appear to provide us what we need, none of them really do, and all of them cost a lot of money. And none of them would exist if that money was not to be made in whatever they are offering. Even care centers for indigent patients – the citizens of our country that as a group have by far the worst health – exist only if there is a way to bill for the costs of that care, and are structured to maximize that reimbursement. All of this is doing nothing to address the underlying fundamental problems of the way we live, the real driving factors in our health.
What should we do?
We fix the system. To do that, both sides – payers and providers – have to sit at the table and restructure things such that the health of the patient is the most important goal, and the money collectively paid into the system by those patients is used to efficiently deliver those state of the art therapies as needed.
How do we do that?
There is no shortage of providers will to sit at the table, you just don’t have the payer side. We create a government sponsored insurance company to fill those seats. This entity would provide people with an option that currently doesn’t exist, independent of employment, finally using competition in such a manner that it works for the people, not for the system itself. This would immediately provide the people of our nation with truly affordable health insurance, and would force a response from the current insurance industry by offering a better product at a lower cost while not being beholden to investors.
Yes, it is complicated, but fundamentally it would look like this: primary care physicians would be tasked with managing the health of the people, and those results would be of paramount importance for financial reward. The use of tests and procedures and therapies would not generate money for those providers as it does now in a fee-for-service world. Instead, the costs of those tests and procedures and therapies would be subjected to a competitive market that finally demands results commensurate with price.
On the surface, these may not appear significant. It may even appear that some current legislation is attempting to do this. It is not. Obamacare exacerbated the issues. Even MACRA (the new physician payment plan for Medicare) and other value-based insurance plans, while adding some performance measures that make it appear they will improve our people’s health, remains fee-for-service. Which means the business folks will find a way to get at the money that is offered.
But what I am talking about represents a complete restructuring of the driving forces in healthcare. If we don’t change the way the wind is blowing, we can’t change the way the boat is going.
And then we change the boat itself. Because through all of this noise, the discussions of laws and doctors and insurance and money and the right and the left, our culture is what we must address. The health off our economy, the health of our communities, the health of our country; these are the heart of the health of our people. These things are inseparable. And when I say that the government is not our solution, it is here that there can be no doubts: our current political system is killing us. To fix our culture, we must come together, something that neither political party is working to do. Because the health of both parties feeds upon that division. We must first fix us. Only then can we address the challenges that we face. We have the ability to do whatever we set out to do, but only if we do it together.