Many readers responded to my ‘healthcare monster’ column. They challenged me with the same query: You nailed the problem, but what’s the solution?
Good question. Here’s a 12-step, 700-word answer, culled from years of reading:
Admit healthcare is a monster.
Before you can solve a problem, you must acknowledge that you have it. We haven’t done that. The fact that billionaires, sheiks and despots flock to the U.S. for medical care only proves that the very rich can afford whatever they are charged. It says nothing about the access to care that most of our 320 million citizens experience. The Affordable Healthcare Act isn’t the problem; it’s just another inadequate solution.
American healthcare has captured all the dollars individuals can pay, all the dollars their employers can pay, all the dollars our government can pay, all the dollars our government can borrow directly and all the dollars our government can borrow from children not yet born. It is a blood-sucking monster. Expect a big fight.
Study healthcare systems that were “not invented here.”
They are doing a better job, with less money. The U.S. ranks at the bottom of the industrialized nations for health outcomes and life expectancy. This doesn’t necessarily mean a one-payer system or “socialized medicine.” It means learn something.
End old habits.
Health insurance isn’t a gift from concerned corporations. It is the accidental result of corporate competition for workers during World War II. Today it functions as a primary tool for insurance companies to Balkanize populations, game risk and exploit poor price discovery. End it. Liberate workers to change jobs without fear.
Restore the insurance principle.
The concept of pooled risk is one of the great inventions of western civilization. Too bad insurance companies avoid it whenever possible by splitting groups and gaming risk pools. Standardized policies, a la Medicare medigap policies, and guaranteed lifetime acceptance for those with pre-existing conditions will work to put the insurance principle back to work, and group manipulation out of work.
End the tax break for employer-sponsored health insurance.
It’s the largest of all tax expenditures, $150 billion this year. Put everyone on an equal footing. Use the increased tax revenue to fund other health-productive programs.
: Support a shift to free medical education for general practitioner doctors and nurses.
Many MDs become specialists because a higher income is the only way they can pay off their medical education debt, typically about $160,000. We need more first attenders, and fewer specialists. This will lead to better integrated care and less pyramiding of medical fees.
Create price competition in pharmaceuticals.
Take big pharma off corporate welfare. Restore price competition. Allow imports. Let Medicare negotiate drug prices. Let’s see what we get from an industry that has to price its products at a level actual people can afford.
Create compensation claw-backs for hospital execs that force understaffing.
Let’s go for civil penalties where accidental deaths are high as a result of staffing policy.
Insist on hospital price menus for procedures.
Promote price visibility and competition. If a hospital can’t put a price on what it does, maybe it doesn’t know what it is doing. Management and health outcomes will improve. Some hospitals may close. Too bad.
End phony price moves for pharmaceuticals.
This includes different ways to extend monopoly pricing for drugs coming off patent such as time capsule reformulations and negotiated deals with generic producers.
Increase end-of-life/palliative care counseling support.
Few people want to die in a hospital after multiple heroic efforts, but it happens all the time. Provide better information to patients on consequences, odds and results for late-life procedures.
Treat addiction as a health issue, not a character fault.
Expand the Gloucester Initiative where the police will help, not arrest, those coming to the police station seeking help for addiction. Broader efforts would include free post-detox access to methadone, suboxone and naltrexone as well as the narcan currently provided to save lives in drug overdoses. Recent demographic research has found that drug use is responsible for actual decreasing life expectancy for some Americans.