The fatal flaw in American healthcare

“Insanity is doing the same thing over and over again but expecting different results.”

In discussions of the healthcare system we have in the U.S., much of the talk is centered around the idea that the system is broken. The most recent estimates of people without insurance put the numbers close to 50 million people. Over 60 percent of bankruptcies are a result of of medical bills. If we allow the current trends to continue, the price of family health insurance may surpass the average family income by 2025. These are not symptoms of a few problems that we can solve through making some minor changes to the existing healthcare system. These are pathological symptoms of a system which is fundamentally flawed.

It is noble for those of us working in the healthcare field to try to do the best to serve the interests of patients. I have deep respect for those on the front lines of the battle for health. The over-worked, underfunded staff of our community health centers. Our primary care and mental health professionals working in our most underserved areas. My fellow Health IT geeks working to utilize technology to combat health disparities and make care safer and more efficient. We’re all trying to do our part.

It’s not enough. It’s not enough to work within our respective silos and hope that healthcare reform will “fix” the system. We need something more! Something that gets past professional pleasantries and acknowledges the fundamental, fatal flaws in our system of health. It requires a holistic approach, as shown by the impact of social determinants of health on our well-being, and it isn’t something that can be solved overnight.

The fundamental flaw in our system, the one that can’t be solved by any mere reform, is that in the U.S. healthcare system it is more profitable to treat sick patients than it is to promote healthy living and prevent illness. This can’t be solved just by introducing a new business model. Even with Accountable Care Organizations, we still don’t address the influence that the Medical Industrial Complex has on how the Federal government makes decisions. That is why we need Occupy Wall Street. We need to be a part of the movement to give power back to the people. we need a mass movement to demand that healthcare should be a social, community good rather than a profit center or commodity.

Please don’t just Occupy Healthcare because it’s the latest buzz word. Get involved in your local occupation, and if there is none, start one! Healthcare is one of many issues facing our society, but it’s a big one. We need to be involved in movements addressing the fundamental, systemic problems facing healthcare today.

Because we don’t just need healthcare reform. We need healthcare revolution!

 

About

Nate is your average friendly Health IT geek. Follow his journey through the Health IT landscape in his blog Bio-Digital Jazz or on twitter @nateosit.

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Posted in healthcare, Innovation
  • HurricaneRB

    I don’t believe just “protesting” leads to any positive outcomes, especially in an age where crowd control has become so well-developed. Look, we just had an election Tuesday where some measures were voted on, and some individuals were voted into office. The ballot is where you make a difference. We need more individuals running for election, we need more citizens placing measures on the ballot. And in order to do this, people must make some personal sacrifices….is that you?

  • NateOsit

    That assumes a level playing field at the ballot box, which is just not the case in the U.S. Lobbyists pay millions each year to political campaigns to influence elections and the national debate. http://www.followthemoney.org/database/IndustryTotals.phtml?f=0&s=0&g%5B%5D=8 Their advertising dollars influence the way issues are portrayed in the media, which after the Fairness Doctrine was repealed in 1987, led to a woefully skewed media landscape.

    I agree that elections have importance in the fight for improving healthcare, especially local elections. National elections, where systemic problems are born, are out of reach for anyone not willing keep the status quo in place. The cost is too great, and there is so much money involved now, especially after the Citizen’s United decision, that it’s insurmountable without widespread, grassroots support. That’s why I think the protests are important. It allows us, as a society, to take a step back and discuss these issues without a corporate media filter or false Democrat/Republican dichotomy.

    • civisisus

      Nate, I’m not sure where you’re going with your notion of revolutionizing our national health care “non-system”, but I’d suggest having models in mind before mounting the ramparts. 3 come to mind:

      1) telecom’s struggles to resolve the economics of its networks’ operating models – good source is Andrew Odlyzko; http://www.dtc.umn.edu/~odlyzko/doc/history.communications2.pdf
      2) early railroad ‘networks’ (see Odlyzko again – he does a good job of explaining why the two confronted very similar operating model challenges) http://www.dtc.umn.edu/~odlyzko/doc/mania02.pdf

      Odlyzko is especially good on the challenges involved in seeing & communicating the revolutionized future – something you may as well start thinking about now, before you fire many more shots

      3) the interstate highway system (Earl Swift’s The Big Roads is as good a primer as any)

      What’s that you say? Neither guy is/was talking about health care? All I can reply is, if you’re gonna revolutionize it, you have to proceed as if the term “health care”, as used now, has no useful meaning.

      • NateOsit

        Thanks for the examples! I think there are plenty of models to choose from in terms of healthcare- Japan, France, and Cuba first come to mind. I think these systems are all a step forward, but still may leave something to be desired.

        One of the points I try to make is that health isn’t isolated from other sections of society. The way we produce and distribute food, clothing, and housing play a huge part in whether good health is an achievable goal. I don’t want to put forward a model and say “this is exactly what we should do” because I think it requires more diverse input from all affected parties to be a truly sustainable plan.

  • HurricaneRB

    Yes, you are very right about the incredible amount of money needed that does not allow real access.

  • http://www.healthcarecommunication.com Jessica Levco

    Hi Nate, I enjoyed reading your post. Do you mind if we re-run it and link back to it on Ragan’s health care website, http://www.healthcarecommunication.com? We can post this on Nov. 21. Thanks! -Jessica

    • NateOsit

      Sure! As long as the content is the same, I’d be psyched to spread the message.

  • http://www.Spherit.com Phil Lawson

    I enjoyed your post and your excellent summary of the situation.

    May I suggest that the situation we find ourselves in may not be due to a singular fundamental flaw as much it is the result of a convergence of a large number of factors?

    For example, while profit from treating the sick is a major issue, the role of profit itself is complex and multifaceted, for example; $4 billion is spent each year on advertising to young children to eat junk food and billions upon billions more is made in the sales of these ‘foods.’

    Other posts on this blog have highlighted the roll the prevailing mindset plays, the importance of access to proper food and places to exercise as well as how current healthcare does not look at the whole of person, that integration of the person and healthcare services is essential.

    The situation is complex, success in changing the situation will require we acknowledge, embrace and address the multi-faceted interconnected whole of the situation.

    I agree with you that we must be involved. Engagement by all parties is required.

    • NateOsit

      I certainly simplified this, but I think that the flaw I refer to creates a chain reaction that feeds into how social determinants of health such as food security, environmental factors, race, gender, and the innumerable other intersecting factors affect health. What I like about the Occupy Wall Street movement is that it is broad and strong enough to encompass this wide array of issues, rather than focus on each individually. A holistic approach to health is desperately needed, and we need a diverse group with many different backgrounds to tackle the problems we face in a comprehensive, effective way.

      • http://www.Spherit.com Phil Lawson

        Nate,

        If I understand your postings correctly, what you are proposing is a fundamental redefinition or even replacement of capitalism (profit) and its role/relationship to democracy and the American way life – which could then potentially lead to improvement in healthcare.

        While this approach may be valuable and perhaps be needed, what I have not heard from anyone is a valid proposal for an approach to doing this that looks at the whole of the situation, how everything is interconnected, much less any specifics on how this could or will be done.

        American society is a highly interconnected interdependent complex system (as in systems science). Healthcare, business, education, religion, government, national and personal debt, personal income and business profits, energy, agriculture, the environment, communities, families and individuals are all intimately connected. A change, even a really good change to one element or aspect of this system can and will have significant ramifications to the entire system, sometimes good, other times it comes with unanticipated undesirable or even catastrophic impacts.

        As a child of the 60s I know from personal experience how easy it is to find flaws in the system and make proclamations of what should be; and how it is quite another matter to successfully change a system without unintended and sometimes significant collateral damage.

        The challenges today are far complex than the issues addressed in the 60s. But I do believe they must and can be addressed.

        That said, I love your enthusiasm, yours and that of others I talk with and read about, it is invigorating and reminds me a bit of the vitality and engagement demonstrated by youth before. I wish you great success in your activities.

  • HurricaneRB

    I think it’s very clear what the problem is, and I commend this blog for continuing to communicate that message. I especially appreciate the stats and real data that is emerging. Changing the situation still goes back to healing the central source of the problem. I’d like to see more about the real measures individuals can take–on the individual level–to make this change. Protesting isn’t the answer to me. If it’s true that the media is controlled by lobbying groups, what the American public sees on TV concerning the protesters won’t lead to change. And for as much as we love the internet–many of us who use it, broadcast television is statistically still the most significant influence of the American people (Advertising Age).

    I want to see some of the authors on this blog really get out there as leaders in the media on this issue. And that often takes making the sacrifice to be “labeled” one way or another with your message. But you will affect change that way. By taking a stand.

    Besides running for office, electing people to office, drafting and creating successful petition measures at the local level, I’ve done a lot of protesting, and what is happening right now is “controlled protesting”. It’s not passing above threshold to effect change. It’s something to talk about to focus attention off more important measure that people CAN change.

    If we want to affect real change, we fight from what we call a “position of strength.” Like in the courtroom, every case has “hooks” you hang your hat on to set your premise and win your suit. What are these hooks for healthcare? Where does the individuals strength lie in affecting this change in healthcare? What can people say YES to, and NO to in their daily lives, where their potency lies, where they make a difference.

    And what about you guys? You are leaders. That is a strength for you. What are you doing in the media to take a stand on these issues and can you talk about that on this blog?

  • http://www.docforeman.com Dr. April C. Foreman

    As a psychologist, serving the poorest and sickest people in rural Kansas for a below poverty level wage…I can tell you that there are so many things that get between me and the care I know I could provide for my community if I were given the chance.

    We have the money, talents, and tools to have spectacular healthcare.

    But what I have experienced, over and over, is resistance. The biggest obstacle I see between Americans and spectacular healthcare is emotional.

    I am ready to provide the mental health care that Americans deserve. Someone just has to let me.

  • Barbara

    I propose this outline as I believe it encompasses root causes as well as solutions. It is a simple, but radical, plan for our collective future. It’s in chronological order: if we accomplish #1 we can do #2; if we accomplish #2 we can do #3, and so on.

    1. Outlaw political contributions to congress and presidents by industry groups (under all their guises).

    2. Stop spending on war. Afghanistan is worse than Iraq. It will
    never end. It has never ended.

    3. Redirect taxes we already pay toward creating the absolute best educational infrastructure on the planet. Pre-K through life.

    4. Put tax money to use for science/engineering/math targeted toward quantum changes in our infrastructure (transportation, renewable energy, waste mgmt, water supply mgmt)

    5. Use the intellectual output from above toward executing projects at ground level (electricity grid, railways, tunnels, bridges, roads, upgrades to buildings, museums and libraries and Internet accessible to all). These upgrades are desperately needed AND will provide good jobs.

    6. Go after the industries that deliver illness to the population and limit their tactics and their access to politicians –AND—TAX their products. The industries include: tobacco, alcohol, firearms, agribusiness. sugared beverage companies.
    Make it possible, but expensive, to buy “Fritos™ and a Coke™.” Example: find some level of sugar/sugar equivalent as we do for alcohol and many other products; exceeding this level in a product should triple the tax.

    7. Make health care available to all and make it universal/single-payer (e.g. having a social security card means you get high quality efficient health care for life).

    We can do all this and more with our existing tax money. There is plenty of money it’s all a matter of which way it flows. Does it flow to the already rich and powerful or does it flow back to those who paid taxes to start with and who, as citizens, have a right to equal representation and the basic human right to live?

    Our species, Homo sapiens, has about 25-30 years within which we can be brave and take truly enlightened action. If we do that, we might also save the planet.

    ~~ in solidarity Thank you

  • http://acowatch.com Gregg Masters

    Oh, the tangled web we weave!

    The profit v. non-profit argument is a slippery slope, though one that needs to be debated in the light of day. To examine non-profit v. for profit business models and make determinations of which is a net positive to the community is a complex question, but one I am willing to engage in.

    Good article Nate! Thanks for starting the thread!!

  • http://thephoenixproject.org Laith Bustani

    We currently have all the tools to redesign the social framework within the existing system so that there can be a gradual, voluntary, and bloodless transition to a new social economy built on the most important and reflective indicators of our wealth and productivity.

    Physicians are in an excellent position to lead this change as the process of gradually reducing suffering in one-on-one iterative steps is the fundamental focus of our art.

    (pre-state, individual_1)(pre-state, individual_2) + Interaction = (pre-state, individual 1- expenditure of energy required for interaction)(productivity of collaboration) + (pre-state, individual 1 – expenditure of energy required for interaction)(productivity of collaboration)

    My salary should be which ever is greater:

    1. Mean salary of the patients I serve
    2. Productivity bonus based on my contribution to improved health and system efficiency.

    I have declared my action. What will yours be?
    http://www.flickr.com/photos/22752754@N07/6320282818/

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