"The private health care industry is not only the largest industry in the US, it is also the most inefficient, the most wasteful, and the most self-serving." Arnold Relman
“Our healthcare system must shift from one that focuses on treatment to one that prioritizes prevention.” David Blumenthal
“We have to stop thinking of healthcare as a business and start thinking of it as a service.” Atul Gawande
We have all felt the inadequacies of the US Healthcare System. The US has built a bureaucratic health infrastructure that is reactionary to and dependent upon disease. There is a lack of focus and investment in disease prevention. Complex billing systems and high premiums, led by profit motivated private insurance companies highlight a system dominated by inflationary administrative costs. Hospital Systems, led by nonclinical business executives, create local and regional monopolies and continue to expand unchecked. This US health system expansion is without purpose or direction. The multitude of private insurers and varying health systems has led to fragmentation of the system as a whole, reflected by poor price transparency, limited competition in most markets is reflected in rising costs; all with low accountability. We are mired in a fee for service model that rewards quantity over quality and short term intervention over long term outcomes. Prescription drug prices, over-utilization, poor integration of health information, and care navigation inefficiencies have led to profound frustration among patients and physicians. The affordable care act has ironically doubled down on this flawed foundation as it placed more power in the hands of private insurance companies and large hospital systems:
To consider the issue from a larger perspective it is important to consider the gaps in our system from a physicians perspective: Administrative burden is responsible for 25-30% of the total cost of US health care, none of that money contributes in any way to patient care or outcomes. Access to care and care navigation through a toxic complex system has significant consequences; unnecessary duplicate testing, delayed diagnosis, and reactionary siloed medicine with poor outcomes. There are purposeful economic incentives in place to prevent integration of medical care, reflected in disjointed care among various competing medical systems. Physician moral injury, working in an inefficient system has reduced doctors to units of labor and productivity. With rare exceptions, physicians are no longer the visionaries that drive health systems resulting in our current model; MBA led medicine run by C suites, venture capital, insurance companies and “non profit” health systems that continue to buy more land and build more hospitals creating more access without purpose.
The nonclinical model of healthcare expansion focused on acute care and procedural intervention, has done nothing to improve the cost of care, access to care, or mortality. There is evidence that it has created more care, most of it unnecessary and unwarranted. Physicians need incentives to create and drive a system that is fully integrated, allowing them to access to all patient health data in a unified multi-specialty collaborative environment. Physicians need to reinsert themselves in the health and wellness initiatives in their communities and combat the growing environmental, nutritional, and sedentary infrastructure that leads to chronic disease.
Mental health care access, public health and preventative care, drug pricing and pharmaceutical influence, technology gaps, education and training gaps, all highlight further maladies in the flawed US system. For now we will concentrate on one:
The most irresponsible gap, and most significant, is chronic disease prevention. The US spends 18.3% of GDP on Healthcare. That investment yields a life expectancy of 76.1 years, which places the US 40-50th globally in overall lifespan statistics. Meanwhile, the US leads globally, with over 60% of the US population having at least one chronic disease and over 40% with two or more chronic diseases. This reflects the overall lack of value in the US Health System. It will come as no surprise that only 3% of the total US Healthcare expenditure is focused on chronic disease prevention. We have a system that invests 3% of its budget to prevent chronic diseases that lead to 75% of the total US healthcare expenditure. This gap is irresponsible considering the investment made.
It becomes obvious that we do not have a system that invests in accountable outcome based medical care. It is known throughout the world with modern medical technology, coupled with advanced physician led preventative health strategies, and simple diet/exercise interventions, that over 80% of chronic disease is preventable.
Chronic disease prevention, health and wellness have become areas dominated by fitness experts, nutritionists, and supplement companies, some evidence based and well intentioned. There is a significant amount of expensive, misleading, and confusing claims in this space. There is also meaningful information and interventions that can be life changing.
I am working with a group of physicians focused on changing the above narrative. We believe strong physician leadership in local communities, grounded in tight patient relationships, with shared updated clinical information and advanced technology we can break the restraints of the current system. The intention of this newsletter is to help make sense of evidence based health wellness and chronic disease prevention. With extensive review of the clinical literature and insight into the modern medical landscape you will be confident in your ability to articulate an ongoing health strategy for you, your family, and community.
“In no other field is the consumer so blind to the cost, so unempowered to seek value.”--Elisabeth Rosenthal