I was recently asked by several new patients why the US healthcare system "sucks."
Here are a few of my thoughts. But I am interested in what you think. Tell me by joining our conversation on our Facebook page - https://www.facebook.com/edgewatermed
The US healthcare system does certain things well, such as pioneering new and effective treatments for cancer, rare diseases, and musculoskeletal conditions.
However, it does a miserable job of matching people with chronic diseases to the care they need. There are many reasons for this:
The way the US healthcare system pays for care is on a fee-for-service basis: I have a sore throat; the doctor diagnoses it as such, prescribes an antibiotic, and I take the pills. That is a minor acute care treatment problem, and the system is designed to deal with a well-defined acute problem.
It is poorly designed to help someone who is obese and, as a result, has hypertension, Type 2 diabetes, back pain, and depression. This complex disease patient requires a primary care provider to manage multiple specialists to maintain or improve the patient’s situation over a long period. Because we do not manage these situations well, the cost for everyone increases, and the system fails these chronically ill patients.
The US healthcare system, which used to be competitive in most communities, has seen the larger providers, such as the teaching hospitals, acquire both smaller hospitals and small physician practices. These more prominent hospitals increase the cost of care by charging more for everything and do not deliver higher quality. We have a more concentrated market for healthcare. Insurance plans have no negotiating leverage when a single hospital dominates a market, and all doctors have admitting privileges there. We all know who the 800-pound healthcare gorilla is in the St. Cloud area.
Over the last 20 years, we have seen an explosive growth in direct-to-consumer advertising. The US and New Zealand are the only countries that allow this. Pharmaceutical companies have expanded our definitions of “need.” As a result, people seek prescriptions for conditions that they should manage on their own without drugs. The opioid epidemic is just the most extreme case of a pharmaceutically-induced demand that ended up with worse outcomes than if the drugs had never been approved and marketed. If you want to manage your care without prescriptions, we can help advise you on healthy and safe options.
We have more sick people. Robert Kaplan, in his recently published book More Than Medicine, notes that 35% of Americans are obese, versus the average of 17% in all other developed countries. We have a sick care system, not a healthcare system. Our system does not reward patients who take better care of themselves.
We need to adequately differentiate between good and bad healthcare in the design of our health insurance plans. The economics of the Affordable Care Act causes health insurers to pay more in claims than to control costs better because of the misguided “medical loss ratio.” Insurance companies make more profit dollars the more they pay out in claims, which is backward.
We spend too much on end-of-life care and not enough on prenatal and early-in-life care.
Finally, we have significantly increased demand for healthcare but have not adequately provided an increased supply of practitioners or changed our medical licensing laws. And Minnesota is way behind the times.
I look forward to your feedback and thoughts, so tell me what you think and ask questions on our Facebook page. https://www.facebook.com/edgewatermed
Warmest regards.
Dr. Lee
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