How big a problem is healthcare?

A recent write up in California Healthline speaks to the amount of waste in the healthcare system and how this is a significant driver of cost.

They suggest that: “1) Our health system is wasteful. 2) We must do more to rein it in.”

As we have discussed on this site:

“Occupy healthcare must go beyond diagnosing and treating illnesses for us to afford improving our  health. We have to start focusing more resources on prevention. As Nate Osit astutely pointed out in a previous post in this forum, incentives are perverse. There are more rewards in our current system to amputate a diabetic’s infected foot than to prevent the infection in the first place.  According to recent CDC statistics, 1/3 of adults in the United States are obese.”

So, how big a problem is healthcare?

Apparently, it isn’t a big enough problem. When our country is on the verge of having the average household health insurance premium surpass the average household income, we are in trouble.

But yet what is being done?

Combine this trouble to the fact that the economy has been in a state of collapse, and families are having trouble simply making ends meet. Adding insult to injury, “between 2003 and 2010, the cost employers paid for family coverage rose 50% to an average of $13,871 a year — and employees’ share of that tab increased 63%. In the process, health care has gobbled up an enormous amount of capital that employers could have used for salary or wage increases, benefits, or hiring new workers.”

So when we break apart our economy, how much is healthcare a driver of cost and how much of healthcare can help decrease cost making it more affordable for families to receive healthcare services? As Evan Falchuk wrote in the Washington Times:

“The truth is, the bad – and treatable – aspects of health care costs (waste, misdiagnoses, wrong treatments) are what’s causing health care’s fiscal problem. The rest represents a golden opportunity to overhaul and grow our entire economy, perhaps the greatest opportunity we’ve had in 100 years. It is these costs that would help create the engine of growth and innovation that could reshape America’s 21st-century economy.”

And Falchuk is on to something here; we are innovative in healthcare, we are just not the most affordable. CMS, under the leadership of the now former Administrator Dr. Don Berwrick, released the folloiwng statment (through Dr. Berwick):

“Health care costs remain a significant drain on the budgets of families, businesses, and federal and state governments. The health reform law, the Affordable Care Act, made significant strides in making Medicare more affordable and insurance companies more accountable. Congress is considering other ways to build on this progress, but we can’t wait to do more to help make our health care system more affordable.”

And boy, did Dr. Berwick get it:

“Health care is broken… We have set up a delivery system that is fragmented, unsafe, not patient-centered, full of waste and unreliable. Despite the best efforts of the workforce, we built it wrong. It isn’t built for modern times.”

So is it possible to increase the economy (and jobs) while simultaneously decreasing healthcare cost? Are the two interrelated? Separable? As Dr. Elliott Fisher put it:

“To slow spending growth, we need policies that encourage high-growth (or high-cost) regions to behave more like low-growth, low-cost regions — and that encourage low-cost, slow-growth regions to sustain their current trends.”

Said differently – we want to take the best of one place and try it in another place that may not be as good. This applies to clinical outcomes and economic outcomes (increase/decrease in cost).

U.S. spending on health care is very high and a source of great concern, but it is the growth rate of medical spending, not the level of spending, that ultimately determines our country’s financial well-being. If current trends persist, we will be spending an unsustainable 38% of our GDP on health care by 2075, as the growth rate of health care costs continues to outstrip the growth rate of the overall economy. In this environment, whether annual health care costs rise or fall by 1% or even 5% is irrelevant — all we do is move the day of reckoning less than 1 year closer or farther away. Clearly, the key to the long-term viability of our health care system is to lower the rate of cost growth, often referred to as ‘bending the cost curve.’”

What are cells called that grow at an uncontrollable rate?

You got it – cancer.

Healthcare costs are growing at an uncontrollable rate. People are and will continue to suffer if we do not change this!

As the brilliant Jonathan Cohn wrote during the debate on health reform:

“However opaque the campaign for health care reform has seemed, it really does come down to those three goals: Making sure that everybody has insurance, making sure the coverage is good, and making sure, over time, that health care costs less. The fallback options, Democrat or Republican, don’t accomplish those goals. Only comprehensive reform does.”

Comprehensive reform was not achieved in the way that can really start to address those three issues Jonathan laid out. Thankfully there are efforts afoot that are looking at doing this, but they are few and far between. And, they take time.

Patients and providers must again choose to vote with their feet. One of the most significant ways to start to decrease healthcare cost is when patients, the community, take responsibility for their own health. We do not wait until we are sick to start to change our lifestyle, we work at it – all the time! Providers choose to work in systems whose main goal is to not find ways to squeeze every penny out of a visit, but do what is necessary to deliver high quality care (more is definitely not better in healthcare).

In closing, the Harvard Business Review has summed it up best:

“Supposedly, everyone working in health care wants the same thing: to help people get and stay healthy. “Everyone” includes primary care doctors, medical specialists, nurses, hospital administrators, health insurance providers, nutritionists, pharmaceutical companies, medical technology manufacturers, fitness gurus, paraprofessionals, public health commissioners, and charities dedicated to a disease The problem is that everyone can have a different view of the meaning of getting and staying healthy. Lack of consensus among players in a complex system is one of the biggest barriers to innovation. One subgroup’s innovation is another subgroup’s loss of control.”

So how big a problem is healthcare? Well for some, not big enough.  This is why we occupy healthcare. More must be done. Hard conversations must be had. Change must be our goal.

Dr. Miller has his doctorate in clinical psychology and is an Assistant Professor in the Department of Family Medicine at the University of Colorado Denver School of Medicine where he is the Director of the Office of Integrated Healthcare Research and Policy. His core task is to integrate mental health across all three of the department’s core mission areas: clinical, education, and research. Opinions expressed here are his own and not those of his employer.

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