A prescription for HealthCare

I have seen much written about the problems with the U.S. health system. As I see it the core issues are: #1 Healthcare is ineffective in preventing and treating chronic diseases. #2 the care you receive is too expensive. The CDC reports that people with chronic disease account for 75% of all healthcare costs. It stands to reason that if chronic diseases were not allowed to become such an epidemic the healthcare industry would not be in the situation it is in today. Americans would be spending at least 50% less on healthcare. Insurance premiums would be substantially less, resulting in fewer numbers of uninsured people. If this was true then covering the uninsured would not cost the government nearly as much, if it became an issue at all. The illustration is overly simplified but the basic premise is solid. Chronic diseases are crippling our healthcare system, making health insurance extraordinarily expensive. Fixing the chronic disease problem will fix many of the biggest problems the healthcare industry is having. From the CDC web page on chronic disease:

“Today, chronic diseases—such as cardiovascular disease (primarily heart disease and stroke), cancer, and diabetes—are among the most prevalent, costly, and preventable of all health problems.”

To understand where the problem began we must go back to the Age of Enlightenment in the sixteenth and seventeenth centuries. The biomedical model was developed using Cartesian reductionism (Cottingham, 1998; Payer, 1988). Scientific reasoning that is mechanistic and linear. Health was reduced to mechanical functioning and established strict divisions between mind and body (Capra, 1982). Such reasons led to the establishment of the modern medical systems, a better understanding of human anatomy and physiology, advanced surgical procedures and the triumphs over the major infectious diseases of the day. Chronic diseases are a major challenge to the modern biomedical model that is primarily concerned with the mechanical functions of the body.

Cardiovascular diseases, many cancers, obesity and diabetes are all heavily influenced, if not out entirely created by our behaviors. The very natures of the diseases create a mismatch between the expertise of medical professionals and the conditions they are trying to treat. The movie Supersize Me makes a good illustration of the point. (the whole video is available on youtube). All three physicians that Morgan Spurlock used predicted only minor changes in his health status. It becomes obvious that their predictions underestimated the ill effects of the McDonalds diet. Just as dramatic was how surprised they where including the comment by the Gastroenterologist that “I would not have even thought about this.” The Cardiologist recommends not eating fast food for a year. I interpret that as saying “I have no idea how long it will take to recover.” If doctors in the movie represent the average medical professional then we must surmise that the underling science they have been taught does not adequately predict behavioral impact on health. Many such examples exist of how mismatched our system is. No surprise given the Cartesian reductionism embedded in the biomedical model they are trained in. To be clear I have no intention of Doc bashing, only pointing to limitations in the current system. In effect we are trying to fit the square reasoning of medical care in the round problem of chronic disease.

Reasonable solutions to current problems have certain characteristics.

First, an effective solution will begin to close the distance between medical and mental healthcare. We need a primary care system better able to handle the behavioral components of chronic disease. The understanding of how the body and mind functions must be based on a model that more accurately predicts outcomes and gets results.

Second, an effective solution would produce the more effective care at substantial savings over the current cost of production.

Third, an effective solution would reward providers for helping their populations stay healthy, as opposed to straight production based compensation.

Fourth, an effective solution would expand the engagement of healthy living to included groups of associated individuals, business communities, and governing bodies.

Many combinations of services could potentially meet these criteria. Many companies can claim that they have produced such a system. The best product with the best price and market position should compete to dominate the market. Healthcare reform should work to encourage and protect healthcare delivery innovation. The successful development of such a delivery system would constitute a disruptive innovation within the healthcare industry. Here in lies the final solution to our healthcare woes, the evolution of healthcare.

Healthcare XPrize

There’s nothing like a big chunk of money to get people motivated. On April 14 the X Prize Foundationannounced a $10+ Million Health care competition. The competition is still in the design phase. What brings me hope in this instance is the fact that at least one open thinker is included on the board of advisors. With Dean Ornish, MD on the board they at least have one known seasoned innovator in the group. I am this night exploring the idea of throwing my hat in the ring for the prize. I would be most disappointed if the usual sort of lackluster health innovators monopolized the event. It would do the U.S. a great disservice to say the least.

I also came across the Health reform pages from the Robert Woods Johnson Foundation. I agreed with the analysis. They suggest six primary areas of needed reforms in our health systems:

1. Cover the uninsured. Coverage must be affordable, open and fair to everyone; it must be continuous and portable. Individuals should contribute to the cost of coverage, but should not be forced to choose between health care and other basic necessities of life. The oversight, management and financing must be responsibilities shared among government, the private sector and individuals.
   

2. Improve the quality, value and equality of health care. Americans pay more for health care and receive poorer health outcomes than people living in all of the world’s other developed nations. Disparities of race, ethnicity, residence, education and income are persistent. It is bad public, fiscal and medical policy to cover the uninsured without also securing for them better quality care that is reliable, safe and fair and provided by professionals and institutions that are publicly accountable for performance and cost.
   

3. Bring down spending. First, ask what can we spend, rather than what does it cost. Then ask how to make health care more affordable. The short-term answer is to develop new business models based on value-added improvements to health and not simply “sick” services rendered. The longer-term answer is to reduce the demand for care by helping people lead healthier lives.
   

4. Prevent disease and promote healthier lifestyles. Whether or not a person stays well in the first place has little to do with seeing a doctor. Our aim should be to keep as many people healthy and out of the health care system as possible. Strategic investment in disease prevention and population health saves lives, strengthens families and the workforce, and reduces health care spending.
   

5. Strengthen public health’s capacity to protect our health. Public health is America’s first line of defense against disease and disaster. Yet, public health historically is under-resourced, has few champions, suffers from a fragile infrastructure and functions so far out of the public spotlight that no one pays attention until after the infrastructure is needed. No sector so critical to the health and security of our people is so casually neglected so often by policy-makers.
   

6. Address the social determinants of health. Treating illness one patient at a time does not improve the health of entire populations or communities. Where we live and work, buy groceries, go to school, who we know, and what we earn all shape our behavior and health. Improving nonclinical social forces affecting health—housing, education, transportation, the economy—may be our most vexing challenge.
   

 

My experience has been that 80% of the health reform chatter surrounds the issues of the uninsured and 20% on everything else. Yet 80% of the solution (or more) is in those other areas of needed reform, especially in the prevention category.  At the very least we are starting to ask the right questions. A brighter day for Health Care is coming, its only a mater of how long it will take till we see it.

Uninsured and American Business

Most Healthcare reform conversations hovers around financial issues. I can see why, as it is easy to understand and relate to something we all know about and are impacted by ….Money. The financial topics can be broken down into covering the uninsured/underinsured, the cost to patients, and the underlying cost of producing health services and goods. Granted the topics are intertwined however they are each monsters of there own and need to be addressed separately.

The debate of covering the uninsured requires an immediate moral judgment. Is this a human right or a service that can be afforded by only those to can afford it? I’ve been told that those with out insurance should just get jobs and work hard. That statement insinuates that somehow they do not deserve access to health services. I’ve also been told that it’s not the government’s job to cover everyone. The creep toward socialism is often cited as a fear that “socialized medicine” in any form is dangerous. Let’s examine this a bit further.

First of all the uninsured and underinsured are made up of working class folks. The back bone of the American economy is made up of small businesses who find it ever more expensive to fund employee health insurance. Half of all small companies of 10 employees or less do not even offer insurance benefits. I personally know of 20 such businesses within a ½ mile of me. How many people are not staring new businesses or are willing to be employed by small businesses because they cannot afford to lose their insurance. By adding significant risk to everyone involved in small businesses, lack of insurance is eating at the very fiber of what makes America great. Having universal health coverage will not solve all of our economic woes. It will ease some stress from would be innovators of today that are needed to create a better tomorrow.