Healthcare

Our healthcare system itself should be in the intensive care unit. We spent 17% of all that we make, produce and earn on healthcare, and we don’t get as much back from it as do other countries which spend much less. In fact, the U. S. health system spends a higher portion of its gross domestic product (GDP) than any other country but ranks 37 out of 191 countries according to its performance, the World Health Organization tells us. For example, Great Britain, which spends just six percent of its GDP on health services, ranks 18th.

The problem is not with the doctors, nurses or others in the healthcare system. They do a great job, and have amazing skills, talents and educations. The problem is the system of how we deliver care. It’s broken so badly it needs to be replaced. Many of the current proposals at healthcare reform are much like trying to get better mileage from a 50 year old car. Even if one can get it to be a bit more fuel efficient, it still won’t be reliable, and you shouldn’t put your family in it for a long trip.

Much of the problem is how we arrange what we pay for. We pay to treat people when they get sick, rather than pay people for providing services in a way that keeps them healthy. In effect, we pay providers to take care of people when they get so sick that they have to go to the doctor or nurse practitioner or physician’s assistant. We don’t pay them for doing such things as designing programs to make sure that they don’t have to go to their physician as often, or only at a time of advanced and more expensive illness.

The better and more cost efficient systems only work, however, if everybody is covered for basic health. With everyone covered people can be treated on a cost per person basis, rather than a cost for procedure basis. This allows creative and competitive approaches which insure an adequate level of care and better provide for everyone’s basic health needs.

As is said, however, there is no end to good care. There is always more that can be done, and that we as patients would wish done, and at some point a line needs to be drawn which defines “basic health care.” This would clarify the kinds of illness that are basic and collectively covered, with other conditions and interventions handled through more traditional medical responses. This implies a two tiered system in which more traditional insurance plans might supplement basic health plans to afford additional coverage for those wanting it and willing to pay for it.

None of the proposed solutions to make this transition to a better system of care are simple or easy, and none of them are a “magic wand” which would make healthcare universally available for all conditions. There are, however, health delivery systems which are different than ours, more humane than ours, and which produce a variety of benefits, in addition to a healthier population. These systems are economically beneficial and reduce overall healthcare costs, but also benefit employers who, under the current system, are handicapped in a competitive world market by having to include the cost of healthcare for employees in their overhead. That cost, coupled with the cost to produce goods or services, creates a tremendous increase in price that other countries don’t have to pay. For decades now it has been the case that the healthcare benefits of the employees of American automobile makers are far more expensive than the cost of the steel in the car. Changes in our system could result in not only a healthier population, but also a healthier economy.

These changes need to occur thoughtfully, but decisively. The liabilities that are predictable and known in the way we currently deliver care have the potential to bankrupt our nation. Not addressing these critical issues can result in a lack of access to care that would be truly devastating to patients, providers and to us all. I have been a healthcare provider for years, serve on the staff of Sacred Heart Medical Center and the faculty of The University of Washington School of Medicine, and have even written a well regarded book which discusses the changing context of healthcare.

It’s been said that “if you don’t know where you’re going, you’ll end up someplace else.” I understand that change is needed and what changes should occur. The time for change is overdue.