Ideal Healthcare System is Somewhere Between the Extremes

KevinMD.com published a good article by internal medicine physician Suneel Dhand. He had worked under UK, Australian and American healthcare systems and brought a broad perspective to suggest that the ideal healthcare system is somewhere between the extremes. He makes good points, and I wanted to respond, but unfortunately comments are closed. That prompted me to post my response here on this blog. 

My Ideal Healthcare System – somewhere between the extremes

Crafting the ideal health system is an incredibly complex challenge that requires systems thinking and better alignment of incentives with goals, as I wrote two years ago in https://www.mhealthtalk.com/get-the-health-incentives-right/. Yes, the ideal system is probably a hybrid public/private model that exploits the different objectives and success measures of public and private sector organizations, and I remain guardedly optimistic that we can get it done, even if that means starting with a broken political system.

With an eye on profitability, America’s medical industrial complex lacks any motivation to support policies or adopt practices that would bring costs in line with other advanced nations, because doing so would cut revenues by some $1.5 trillion/year. Congress would have to force that upon them, but they’re unlikely to do that, given that they get nearly twice as much in campaign contributions from the healthcare industry than from the military industrial complex.

Consumer incentives are also misaligned with wellness goals. Even with high-deductible insurance policies and other measures designed to encourage them to seek the best value in healthcare choice, that’s not always possible. Sometimes it’s because hospitals keep their charges secret, and knowing the total cost ahead of time is nearly impossible. Other times, such as during an emergency, there’s just no time to comparison shop. Drug company TV ads targeting consumers and ending with, “Ask your doctor,” don’t help, and this could be worse with a universal healthcare system if it doesn’t get the health incentives right.

The value of this article is the broad perspective of the author, having worked under different systems, but crafting the ideal health system needs an even broader perspective that includes all stakeholders and not just those with deep pockets and political influence. At Modern Health Talk (mHealthTalk.com), I write about the future of healthcare and health reform from the perspective of a 40-year technologist, consumer advocate, and futurist.