Reengineering U.S. Healthcare
What are the economic benefits and challenges to reengineering U.S. healthcare? I address those questions in this brief article, which is shorter than many others at Modern Health Talk. I’m writing in response to an article by Clifford Thornton-Ramos, because LinkedIn limits what can be said in comments.
In a rather long article published ten days ago, Clifford called for a meaningful and far-reaching transformation of U.S. healthcare. As I read through it, I compiled a list of topics where I agree or think he missed the mark. I especially liked his stats listed up front and conclusion at the end. In the middle were a ton of quotes but with no attribution, thus making them largely useless. Also helpful was his table, Charting the Key Healthcare Issues.
I certainly agree our nation’s healthcare system needs reengineering. The health and economic benefit potential is immense — over $2 trillion PER YEAR — but the powerful medical industrial complex has resisted. It has three times more lobbyists in Washington than the military industrial complex and could even justify spending a trillion dollars in a single election cycle to avoid meaningful reforms.
Our nation’s healthcare profit motive is misaligned with public health, and even Goldman Sachs admits that “developing medical cures could be bad for business.” Better is to treat patients as paying customers and keep them coming back, paying. So, medical schools place little emphasis on prevention or the pillars of wellness: exercise, nutrition, sleep, and stress management.
It wasn’t always like this. American healthcare once had altruistic patient-centered roots, but since President Nixon, medical insurance companies, hospitals, drug companies, testing companies, and medical equipment providers have been allowed to act as profit-centered commercial enterprises. Making matters worse, they are increasingly funded by private investment bankers and paid to deliver treatment, not cures. All of this has left us with a profitable Sick Care system rather than a Health Care system. American healthcare has been on a downhill spiral ever since. I wrote about that in an article describing Profit as a Disease, and Now an Epidemic.
WHERE TO START?
Bernie Sanders famously promoted Medicare for All, a single-payer system. It would be a good start but likely not enough in my view.
I look at this problem from the perspective of a retired IBM technologist, market strategist, futurist, and consumer advocate, with over 50 years of experience with product development and international standards. In my view, the place to start is with an agreed upon set of objectives — a goal. This approach works well for developing technology products, and I’d like to see it applied to healthcare. From what I’ve seen, it’s much better to start with a deep understanding of the problem before setting engineers free to start developing. To do that, we must overcome our pride and think critically.
There’s a myth that America has exceptional healthcare. In a few rare cases we do, but we must get over our pride and realize our faults. Even though the U.S. has the most expensive health care system in the world, we rank dead last in terms of efficiency, equity, outcomes, and longevity. The primary cause of our broken healthcare system is our broken political system, and the extreme inequality that fuels it. It’s like every company in this industry is working to protect its slice of the healthcare economic pie without thinking about how to grow the economic pie of the entire nation.
Consider the economic potential of “reengineering” our healthcare system to meet the objective of just becoming average. That’s where my $2 trillion/year benefit potential comes from — matching the spending and outcomes of peer nations. But why settle for just being average? Why not set our sights on surpassing Singapore to provide the cheapest and most effective healthcare system in the world?
Economic benefits don’t stop there. With national objectives focused on improving public health and workforce productivity, might we also focus policy decisions on other ways to improve our health and productivity, such as addressing pollution and improving the environment, along with better housing, public education, and other factors supporting a wellness objective? Companies would become more productive and profitable, GDP and global competitiveness would improve, and standards of living would improve immensely too. And without the need to offer health insurance as an employee benefit, companies would be able to pay higher wages. Workers, freed to seek better employment elsewhere, would demand it, and whole ecosystem would benefit as a result.
One area of public health we might focus on is sleep wellness. According to the CDC, “Insufficient Sleep is a Public Health Epidemic,” and getting enough sleep is an absolute necessity, not a luxury. They also say sleep quality should be thought of as a “vital sign” of good health because of the many ways it impacts us overall. After retiring from IBM, and while working as a sleep economist, I studied and modeled the economic benefits of good sleep, both for individuals and the nation as a whole. I wrote about the potential benefits of policies aimed at population sleep wellness. It was easy to project millions of dollars in improved net worth of individuals and trillions for the nation as a whole.
ABOUT THE AUTHOR
Wayne Caswell is the Founding Editor of Modern Health Talk, an altruistic website and blog with hundreds of published articles on healthcare policy, technologies, and solutions for independent living. It started in March 2011 as a nonprofit effort to share the unique perspectives of a retired IBM technologist, market strategist, digital home consultant, futurist, and consumer advocate.
