I should say at the outset that I have no guaranteed fix for the US healthcare system. I suppose the first thing we need to do is to recognize that in the United States, we don’t have a true healthcare system. What we do have is an overpriced “Illness Machine.” This Machine, driven by the medical-industrial-congressional-insurance-regulatory complex, “so-called “stakeholders,” takes trillions of dollars and turns them into jobs and profits for themselves, with little concern for what they’re actually supposed to be doing–improving the health of the people of our country. These stakeholders have taken a hammer, changed its name to “an impulsion device,” and increased its cost to $500.
This point is driven home eloquently by Michael Lewis in his book The Premonition, which details the bungled handling of the Covid-19 Pandemic by the United States. To paraphrase him, we don’t have a national public health department, but we do have many thousands of underfunded county health departments, each beholden to politicians wherever they are. And these local health departments dare not “rock the boat,” by such actions as publicizing TB epidemics, particularly in minority communities in wealthy towns and cities, or the personnel involved will lose their jobs. This problem is not a new one.
I have watched incentives embedded in “Obamacare” drive up costs by encouraging hospital consolidation, and the purchasing of physician practices of all sorts by Hospitals and Hospital Systems. These incentives are well explained in retrospect in the literature, but we saw them at the time the ACA was passed. Our representatives in Congress, lobbied by “stakeholder” experts from the insurance, hospital, and pharmaceutical and medical device industries, were actually made to believe that creating these monopolistic entities would improve care and save money at the same time. If their beliefs had anything to do with their votes.
I and my team at RNI have advocated for independent practitioners in Medical Care for many years. We have always realized that one size does not fit all–that health care in rural states cannot be delivered as it is in larger cites and urban centers. We realized from our visits to rural areas and small towns in Kansas and Missouri, that providers in rural areas are driven by different incentives from those providers in urban clusters. Yet policy has rewarded consolidation of providers and lack of competition, rather than other motives in healthcare.
Our team at RNI over the years has made public comments at Washington D.C. meetings of MedPAC, the Commission that advises Congress on Medicare policy. We have also addressed the Kansas Senate committee on Health policy, to encourage lawmakers to adopt bills requiring hospital owned providers to post notices that they are hospital owned, and for hospitals and their providers to provide pricing transparency. And we have advocated for this policy long before it became the buzzword in Washington that it is today.
The fact still remains that all services, including outpatient physician visits and outpatient testing cost up to three times more when carried out in a hospital owned clinic or testing facility. Surgery continues to be rewarded in our current Medical care model far more than preventive medical care. And we still have no national public health policy, with local public health remaining the political football it has always been.
One step in the improvement of our Medical Care System would be to nationalize our Public Health Departments, and take them out of the control of local politicians. We cannot afford another disaster like the inept management of the recent coronavirus pandemic.
Another step would involve payment for Medical Care services: payment should be the same, regardless of whether they are provided by hospital-owned or insurance-owned clinics, or by independent ones. This policy is referred to as “site neutral payments.”
Many other steps could be taken to improve the health of the people of our nation, and reduce the costs. Here are two videos with other suggestions about what it would take to improve our Medical Care system.
Here is his outline of what needs to be changed in our healthcare system.