The Problem to be Solved

I continue to hear physicians in our state rant about ObamaCare, as if the latter is the root cause of healthcare’s ills, rather than merely a symptom (or solution, depending upon your politics).  We humans use our cultural biases and personal experiences to form (correct or incorrect) assumptions about changes in our world, too often failing to deeply understand the root cause of those changes.

I maintain that ObamaCare is NOT the problem to be solved; the Sustainable Growth Rate (SGR) and its offspring, Sequestration, are NOT the problem either; whether Governor Deal will or won’t expand Medicaid in the state – also, NOT the problem for us to solve.  What then?

The root cause of all those symptoms is in fact The Cost of American Healthcare.  That high and rising cost ($8,000 per year for individuals, $12,000 per year for families) is the problem causing the symptoms (2010 ACA legislation, 50% of state budgets used for healthcare, and the 2013 Federal Sequestration).

Here are some more symptoms: (1) employers shifting costs to employees (changes in benefit structure and financing of those benefits), (2) uninsured or underinsured individuals shifting costs to the general economy (see spike in personal bankruptcies due to healthcare bills, the cost of caring for the uninsured or underinsured and the cost of diminished productivity), and (3) the general economy struggling from lower spending in areas other than healthcare (innovation, education, infrastructure, the environment).    Dr. Atul Gawande revealed we physicians are part of the problem (New Yorker, “The Cost Conundrum”, June 2009), and Mr. Steven Brill revealed so are hospitals, pharmaceutical and device manufacturers (Time, “Bitter Pill”, March 2013).

So what’s the sustainable way out?  I see a short list of choices:

  1. Price controls (what Mr. Brill argues)
  2. Mandate all insurers be non-profit, coupled with community rating (our model in the US 1940-1960, and one of two European models today)
  3. Payment reform coupled with a free market (partially underway in the US – see  ACOs)
  4. Rationing of healthcare expenses (see UK or Canada)

What’s your preference?

One thought on “The Problem to be Solved

  1. I vote for payment reform coupled with free market choices, which is the direction in which the ACA is moving. The resultant transparency of health care organizations will allow those who provide quality, evidence-based medicine at lower costs to lead a quiet revolution in the coming years.

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