Sunday, June 30, 2013

U.S. Health Reform from 30,000 Feet 25 Years Later

In 1988 I wrote And Who Shall Care for the Sick?  The Corporate Transformation of Medicine in Minnesota.  Today,  The New York Times, in an Executive Pay Column,  indicated  Stephen J. Helmsley, CEO of United, last year pulled down $13.9 million in total compensation. United is Minnesota’s largest single employer and has revenues of over $110 billion.
These figures say much what has happened to health care over the last 25 years.   It has moved front and center as one of America’s fastest growing national industries. It now consumes $2.7 trillion and 18% of GNP.  Everybody says its growth is unsustainable, and national reform must rein its costs in.
Scant evidence exists that this reining in is “bending the cost curve down, ” The rise of the Internet and the social media continue to  herald every medical “breakthrough,” every lung transplant for 10 year olds and every  heart transplant for former vice-president.  Americans continue to obsess over access to the wonders of medical technology,  and despite the public’s compulsion to lose weight,  eat more organic foods,  and down more dietary supplements and vitamin,  we grow fatter and older each passing year.   We  continue to equate health care with health,  although health care accounts for only about 15% of the nation’s health,  the rest related to poverty,  educational levels,  other socioeconomic differences, bad living habits, and our culture in general.
The problem with health reform and bringing down costs comes down to human fallacies and fantasies.  
·         We want to have our cake and eat it too,   to lower costs and lower taxes while increasing benefits and health yields.  

·         We want a “free lunch” from government entitlements without paying for them ourselves. 

·         We want more compassionate primary care physicians, but we don’t want to pay them more, and we don’t want to acknowledge their debts, in time spent getting there, 12 to 15 years, and in educational expenses, $150,000 to $200, 000 on average. 

·         We want all those wonderful  wellness products to save us from our bad habits. 

·         We fantasize about routinely living past 100 or even 120 while fantasizing about remaining forever young.  

·         We crave and stress  more individualism through our iPods, iPads, and other mobile devices by connecting with each other every minute of every day, while consolidating into ever larger Internet-based organization providing ever large amounts of health and disease based information,  some of it real, some of it spurious, without knowing which is which.

·         We want to think analytical computer-based artificial intelligence, through outcomes research and IBM’s Watson,  can save us from our intuitive follies,  but in our commonsensical  heart of hearts, we know it ain’t so.  

The news tell us  we are headed towards an Obamacare “train wreck.”  The polls say the majority of us disagree with the new health law.   

What shall we do?  I suggest we look at the world from 30,000 feet and take a deep breath.  

It’s dizzying  experience. Oxygen is in short supply here.
Tweet:  Oxygen is in short supply at 30,000 feet when viewing the accomplishments of health reform over the last 25 years.

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