My Comments: What follows is a profound commentary on the current state of health care in the US by Dr. Charles Hobson, a health care provider here in Gainesville. Additionally, my post dated last July 5, 2019 will add some insights into how we got to where we are today. I find it ironic that the insurance model we have today can be partially attributed to perceived threats by the medical profession almost 100 years ago.
Apart from the health care provider perspective presented so well by Dr. Hobson, the economic implications of the mess we’re in today are staggering. As an insurance agent for over 40 years, I watched premiums increase by almost 10% per year, every year. If you extrapolate from that for another 40 years, you’ll realize the trend must to be reversed. If allowed to continue, the dollar outlay for health-care costs in this country will exceed every other component of our Gross National Product, or GNP.
Given that cannot happen, it’s painfully obvious that changes are necessary. I for one, assuming I live long enough, will appreciate the ability of my children and grandchildren to remain insured, without having to otherwise live like paupers.
A meaningful discussion on the future of health care in this country has begun and it must be continued. I strongly believe a meaningful solution will have to be developed at the federal level and soon. If you are interested, also check my post from September 26, 2019.
by Charles Hobson, M.D. \ Sep 15, 2019 \ The Gainesville 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 in 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 to 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 compare one against another. The information to do such analysis exists, but it is stored and transmitted and analyzed on hundreds of different systems 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 this country, by patients and providers, is unconscionable and is due 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 America 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 minimum 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 these 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 provide for the money we pay into health care.
We are literally on the cusp of a system that provides much better care at a lower overall cost – if we can make the jump.
Dr. Charles Hobson is a surgeon and intensivist with the Malcolm Randall VA Medical Center in Gainesville, Florida.