What Is the Future of Health Care in the US?

My Comments: Regardless of our political beliefs, health care has an appeal for all of us. We can argue whether it’s a fundamental human right or not, dispute it’s effectiveness or what it ultimately costs, but for each of us, staying healthy has advantages.

If you follow my blogs, you’ll know I’ve expressed myself as being in favor of a re-invention of the health care delivery system here in the US. What we have today is a bastardized version of what has evolved over the past century and is known as the insurance model. The result is a health care cost structure where collectively, we pay a far greater amount into a system, for arguably less favorable outcomes, than any industrialized country on the planet.

I really don’t care how we got to this point. What I care about is that we have a national discussion about how we either change the insurance model going forward, or replace it with something that serves me and my children and my grandchildren more favorably.

The current system, from a national economic perspective, is a disaster. Under the insurance model, the annual cost increases, roughly 10% per year for the past several decades, are increasingly unsustainable. If I were younger, I’d either have to go without insurance, or be prepared to die before I’m ready.

There’s another cost which is not easily measurable. What is the economic cost to society if we have a significant percentage of our population sick and unable to work? How willing are we as a society to let people suffer, be unable to work, and ultimately die sooner than necessary?

The following appeared in the Gainesville Sun this past Sunday. The author is a physician with the largest single payer health care delivery system in the US – the Veterans Administration. He favors a different system than what has evolved as I described above.

The challenge is to reduce a highly complex inter-connected process that’s evolved over the past century into sound bites, short snippets that will cause people to understand. I don’t have an answer for this problem. What I do have is a small forum where I can write about it and hope that my few words will encourage others so that collectively we can find a remedy. I truly appreciate the words below from Dr. Charles Hobson. We either find a remedy soon or we can kiss our asses goodbye.

By Charles Hobson \ September 15, 2019

Special to The Sun

One of the most important and controversial issues facing the nation, and the candidates in the upcoming presidential election, is the poor value Americans get from our health-care system.

Americans often get great health care, especially in a city like Gainesville with excellent providers and hospitals, but that care comes at an exorbitant cost: currently over $3.5 trillion per year. Per capita spending in this country in 2017 was $10,224 compared to $5,280 for other equally wealthy countries. At the same time many of our health outcomes lag far behind these countries, and many Americans are underinsured or even completely uninsured.

The only way toward better value in health care is accurate and transparent information about both the costs and the quality of health care — so that treatments can be evaluated for their value to patients and so that providers and hospitals can be compared one against another. The information to do such analysis exists, but it is stored and transmitted and analyzed on hundreds of different systems — one for each delivery system and for each health insurer.

Everyone has dealt with that misery. Information systems on the delivery side are improving, slowly, through the use of electronic health records. But the amount of time, energy and money wasted on health-care administration in this country, by patients and providers, is unconscionable and is due to the private health insurance system in this country.

Health information systems used by insurers are proprietary, opaque and different for every payer. Physicians and hospitals have to deal with tens or even hundreds of different systems, each with its own rules and procedures. America has been struggling with this problem for over 50 years.

Arguably the single most effective, and most popular, reform made to the American health care system was the institution of Medicare in 1965 — a single-payer insurance system for those Americans age 65 and over. Medicare is strikingly efficient, spending about 2% of revenue on administration compared to 12% to 18% for private insurers.

It is a universal-coverage system — every American citizen qualifies once they reach 65. Most polls put Medicare popularity by patients at higher than 80%, and thus the enthusiasm in many quarters for Medicare for All.

I’m an ICU physician at the main single-payer health care system in the U.S. — the VA. I’ve also worked at Kaiser Permanente, a private single-payer system, and I’ve worked in the private sector.

Most providers, wherever they work, want to be able to care for their patients well and with a minimal of administrative hassles. The massive simplification in a Medicare-for-All system would provide huge benefits for physicians and the rest of the delivery system.

With every American carrying health insurance, no hospital would ever again have to provide uncompensated care. The benefits for the American citizen would be even greater. Aside from the moral imperative for universal coverage, and the importance of health insurance in insuring the actual health of the populace, the American economy needs this badly.

Employer-sponsored private health insurance is an increasing drain on companies, especially small business, and profits lost due to health-care costs continue to increase every year. Bending the cost curve of health care in this country would free up resources to be used more productively by health-care providers and more profitably by business.

Furthermore, the tools to measure value in health care are advancing rapidly, and those tools combined with a single information structure will lower health-care costs not by cutting services or by restricting care, but by increasing the value provided for the money we pay into health care.

We are literally on the cusp of a system that provides much better care at lower overall cost — if we can make the jump.

Dr. Charles Hobson is a surgeon and intensivist with the Malcom Randall VA Medical Center in Gainesville.