11 Pragmatic Observations about U.S. Health System

1. The U.S. health system is the most expensive in the world and will remain so as long as patients demand and expect the latest in hi-tech, pay specialists the most who deliver that hi-tech, and maintain the current legal system which encourages trivial law suits and casino-like rewards should high-tech fail.

2. The health system accounts for only 15% to the nation’s health, the biggest contributors to health and health statistics are poverty, health habits, diet, drug use, violence, lack of exercise, and deteriorating family structure.

3. The key to overall health improvement may lie in the realm of prevention , but prevention depends on the public’s willingness to change their general behavior and the transformation of culture, and most people are much more willing to pay for established diseases rather than theoretical preventive measures.


4. America leads the world in obesity and smoking rates and associated complications; unless obesity and smoking rates decline, these problems may break the health care bank at government, employer, and personal levels.

5. America has the most innovative hi-tech sector in the world, but Gee Whiz Hi-Tech Bang technologies, will not and cannot reverse irreversible chronic diseases, still after age 75, the U.S. produces the best results.


6. Government intervention, corporate consolidation, and the necessity of management skills (marketing, coordination, and capital formation) have contributed to the decline of private practice and physician shortages.

7. In the future, physicians will be among the highest paid and most in-demand professions, but most of the money will continue to go to specialists (orthopedists, cardiologists, gastroenterologists, urologists, oncologists, dermatologists, radiologists, and surgeons) rather than generalists (family physicians, general internists, nurse practitioners and physician assistants).


8. High tech apps – wearable and implantable recording devices, telemedicine virtual visits, non-invasive virtual devices (GI cameras and virtual colonoscopies), patient-owned medical record thumb drives, and ubiquitous electronic health records, are the coming things but must be protected from hackers.

9. A sizable percentage of physicians, frustrated by governmental and corporate controls, will break loose from the system, and 3rd party control and coding and regulatory demands by entering concierge direct cash practices and setting up urgent care and focused diagnostic and therapeutic centers for ambulatory patients.


10. The legacy of ObamaCare will be that its provisions, in particular, individual and employer mandates, comprehensive health plans for all regardless of pre-existing conditions, have changed the U.S. health system, forever, sometimes for the better, sometimes for the worst, and always with unforeseen consequences.

11. Any Republican plan to replace or repeal ObamaCare in part or in its entirety is unlikely to succeed unless it specifically addresses how to take financial care of the 11 million or so who signed up in good feaith for ObamaCare subsidized health exchange plans,