IV. Implications for health care reform

Understanding health care in America—the future

Overview

It would make no sense, after 110 years of health care history in America, for this book and/or this author to try and dictate what needs to be done to fix the current problems with the U.S. health care system. However, the goal of this book is to enhance readers’ understanding of health care in America from a macro-level viewpoint. Based on the discussions in this text it seems clear—as a retired health care provider, advertiser, social scientist, and consumer—that mini-fixes are unlikely to solve the clinical and economic issues related to access and delivery in America. Riedl (2017) in “Health Care Will Bankrupt the Nation” reported that “the national debt is now projected to soar to an unfathomable S92 trillion over the next 30 years” (para. 1) and he went on to clarify the central cause for this steep rise. “What is driving the federal budget into bankruptcy? Health care spending” (para. 2). And while it might be hard for the average American taxpayer to fathom $92 trillion dollars, it is not just the federal government that is facing bankruptcy due to health care access and delivery. Himmelstein et al. (2019) reported that over 500,000 American families file bankruptcy annually related to health care costs and/or lost wages from illnesses/ injuries. Consequently, it should not be surprising that a Gallup Poll reported, “seventy percent of Americans describe the current U.S. healthcare system as being ‘in a state of crisis’ or having ‘major problems’ ” (McCarthy, 2019, para. 1). While there seems to be a consensus among American consumers that health care in the U.S. is in a serious state, there is not a similar agreement on how to address the severe economic issues that have resulted.

While some have cited universal health insurance as a way out of the health care crisis, it seems obvious that we can only expect partial benefits from such a move. For example, researchers writing in The Lancet (2020) stated, “more than 37 million Americans do not have health insurance, and 41 million more have inadequate access to care (Galvani et al., 2020, para. 1). So in spite of the ACA and employer-based, as well as Medicare and Medicaid, health insurance, nearly 80 million Americans have less than optimal access to health care delivery. The authors of the article go on to note that if a national universal health insurance plan was implemented in the U.S. there would be cost savings over all the current plans, or lack thereof.

Taking into account both the costs of coverage expansion and the savings that would be achieved through the Medicare for All Act, we calculate that a single-payer, universal health-care system is likely to lead to a 13% savings in national health-care expenditure, equivalent to more than US$450 billion annually.... The entire system could be funded with less financial outlay than is incurred by employers and households paying for health-care premiums combined with existing government allocations.

(para. 1)

While the social justice issue of health care for all would be addressed by such a universal plan, as well as cost reductions, and perhaps even improved health outcomes with national coverage, countless other problems in today’s U.S. health care system would not.

Galvani et al. (2020), report that such a change in universal health insurance would reduce American health expenditures by 13%. However, according to Sherman (2019), “a new analysis from U.S. federal government actuaries say that Americans spent $3.65 trillion on health care in 2018” (para. 1). Therefore, such a change to universal health insurance would still leave over $3 trillion of annual health care costs. Consequently, the question this book hopes Americans will ask themselves and their government is, “does it make sense to attack a crisis with independent tactics?” (e.g., universal health insurance). Or should there be a strategic plan to impact all of U.S. health care access and delivery', not just health insurance?

To be clear, changing health care access and delivery for all Americans should be a top priority of any change proposal. However, reducing the cost of health insurance does nothing to address many of the health and/or economic related issues pointed out in this book, including:

  • • Disease-focused, biomedical approach to health care access and delivery
  • • Cost of health professionals’ education (especially MDs and DOs)
  • • Disproportionate number of specialists versus PCPs
  • • Lack of a patient focus in U.S. health care
  • • Managed care policies’ impact on providers, institutions, and consumers
  • • Patients’ health literacy issues
  • • Consumers’ education about health, wellness, prevention, and illness/injury risks
  • • The impact of consumers’ behaviors on their risk of illness/injury'
  • • Provider power and control in consumer-provider interactions and decision-making
  • • Pharmaceutical and medical device advertising, profits, and unregulated costs to consumers/taxpayers
  • • Hospitals increasing efforts to purchase physician practices and other hospitals in order to build larger health care systems
  • • Decreasing hospitals and PCPs in rural areas
  • • Lack of standardized, nationally accessible EMRs
  • • Medical errors
  • • Malpractice litigation caps.

These diverse issues are at the heart of this book’s view of the health care crisis. As this text has tried to point out, America does not have a single health care problem, it has a complex, inter-related set of organizational, capitalism, and communication issues and unless all of them can be addressed in some consistent and meaningful, not politically biased, way, it would seem likely that a band-aid approach will continue to be chosen, instead of a curative one. Furthermore, as is currently being demonstrated in the courts, if one political administration chooses to develop a plan (e.g., ACA or universal health insurance), then the next administration is likely to try and overturn it.Without a national consensus, this political whiplash is likely to continue with taxpayers and health consumers paying the price (clinically and financially).

As a result of these political gyrations, America needs a national referendum, not by politicians, but by citizens, that addresses health care from a macro-level perspective. The U.S. as a culture needs to determine collaboratively its values and beliefs related to health care access and delivery. Americans need to understand the consequences of the various choices—what the economic and/or health care outcomes costs will be with the status quo, universal health insurance, or broad changes to the system, and so forth. If taxpayers are accurately informed about the economic risks in their lifetimes, as well as their children’s and grandchildren’s, to the various options, then empowered decision-making can occur. However, this national conversation should not just be about insurance, it needs to be about all aspects of health care, from how it is taught, to how it is practiced, managed, litigated, assessed, etc., etc. Including the consumers’ role in all aspects (from literacy to knowledge, as well as their health care behaviors) of wellness/ illness/injury. For too long, providers were seen as having all the knowledge and therefore power in U.S. health care; however, as discussed previously, that focus has evolved and today, for the most part, insurers now have the most control and power in health care access and delivery. Consequently, it is time for America to assess how citizens want to be engaged in the health care debate. Do taxpayers/ health consumers want to be relegated to the whims of politicians and/or third party insurers, as well as providers—or do the ultimate financiers and recipients of health care delivery in America want to control both the system and their own futures? The answer to those questions hopefully will be determined by U.S. taxpayers. However, in the hopes that Americans will want to revise how health care is accessed and delivered in the future, this book seeks to provide catalysts for various key discussion/decision topics.

 
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