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Our Health Care System May Be Failing, But It Isn’t Broken

Discussion in 'Hospital' started by The Good Doctor, Jun 21, 2021.

  1. The Good Doctor

    The Good Doctor Golden Member

    Aug 12, 2020
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    Adapted from Rich & Dying: An Insider Calls Bullsh*t on America’s Healthcare Economy.

    I’ve stood in front of conferences before and made my case: our health care system is perfect.

    “A perfect system? Ours?” I’ll hear people in the audience murmuring, “He’s a little bit crazy.” And I can understand why they do.

    For decades, critics of the U.S. health care system have described it as broken, and in describing its failure, they’ve focused on surging prices leading to unaffordable health care interventions, driving further division of our socioeconomic classes, and so on. As a result, their solutions to the “broken” system begin by driving down costs, with cheerleaders for the free market on the right and more government involvement on the left.

    They see systemic failures and a broken system. I see a perfect system that’s failing systematically.


    Why would I describe our system as perfect when I think it’s failing too? Because I think we’re evaluating and measuring it the wrong way. Deciding what’s perfect and what’s not depends on what you measure. If you choose to measure our system by the outcomes it drives—low-cost, high-quality care—then it’s not perfect at all. But what if you look at it as a jobs creator that propels our economy? I’d go so far as to argue that if it’s not what it’s designed to do, it’s certainly a job it does well.

    By evaluating our system the wrong way, we’re overlooking its core strengths. And we’re not going to bring about the sustainable change we need until we recognize and agree to preserve those strengths.

    Five points of perfection

    If we want to build on our current system’s strengths, we must focus on its points of perfection, the first of which is economic growth. We’ve built our society on the foundation of growth driven by the health care sector, and we don’t often recognize that. Think how hard it is to create a small company that generates enough money to pay your salary and benefits. Health care does that for millions of Americans, more than any other industry in our country. In most states, the single largest employer is a health care company. Where would we be without that engine?

    The second point of perfection is our system’s nobility of purpose. Experience has convinced me that the people working in health care, either in the direct delivery of care or the ancillary sectors that surround it, are good people. I’d even go so far as to say that you’ll find some of the smartest, kindest people in the world working in the American health care system. They’re not failing us; the system is failing them.

    Our third strength pertains to incentives that reward. I don’t want to get all Ronald Reagan here, but the fact there’s so much money in American health care makes innovation and invention very lucrative. When you come up with a robot guided by a surgeon’s hands that’s more precise than the surgeon herself, or software that improves multibillion-dollar workflows, or a new blockbuster drug—name that invention—you help all of society progress. In America, you can reap the rewards for your best ideas. That’s a good thing—and it would be a better thing if we captured that energy and directed it in more meaningful ways.

    Our fourth point of perfection is the fact that between 1800 and 2000, life expectancy in this country increased from forty years all the way to about eighty-one years now. That’s exponential growth. Now, for some, living longer has meant living longer with chronic illnesses; for them, the quality of life has arguably declined. I’d rather be hit by a bus in America than anywhere else in the world, but I can’t say the same for being struck by chronic disease. Still, for many, simply living long enough to see their grandchildren is a measure of the success of the system.

    The final strength of our system relates to health care’s ripple effects. When we think of health care, we think of physicians, hospitals, insurance companies, and pharmaceuticals. But the ancillary dimensions of the health care system—and the jobs they create—are many. There are more dialysis centers in America than there are Taco Bells, requiring daily supply chains to service them. Professors across the country teach vocational, undergraduate, and graduate students in a myriad of fields related to health care delivery, administration, and public health. Construction companies build profits as well as new hospitals as their local health system expands. Everywhere you look, you find the indirect benefits of health care’s rippling economic impact.

    Preserving what’s perfect

    When we make the mistake of talking about fixing our broken system, we tend to speak of driving costs down or of achieving greater efficiencies by stressing preventive care. There’s nothing wrong with efficiencies and prevention; that’s exactly what an (im)perfect system needs. But if that’s all we set out to do, we simply won’t have the same number of jobs that we do today. I’d argue that we can’t afford change at that price, not without shaking our economy to its foundation. The effects would be devastating. It’s neither plausible nor realistic, and it’s certainly not desirable.

    I think there is a way to preserve the jobs while creating a system that delivers higher value for the same spending. As a practical matter, that means holding the percentage of the gross domestic product devoted to health care at about the same level: 18 percent. As the economy grows, health care spending (in dollars) can grow with it. It’s not a question of how much we spend but really how we spend it. And it’s not a matter of eliminating jobs, because we want jobs. It’s a question of what those jobs are and how to teach people—who now fill jobs created only by inefficiencies—to do the jobs we need done today in a modernized system.

    There was a time when the coming of the ATM was feared because tellers would lose their jobs. And in fact, the ATM enabled banks to reduce the average number of tellers from twenty-one to thirteen in each branch. The tellers’ biggest fears were coming true. But the net effect actually led to more jobs, not less, because by reducing the cost of running a branch, banks were able to open more of them. The only difference was that some of the tellers needed to learn new jobs that required new skills, which paid higher salaries as they shifted from monotonous processing to handling much more complex transactions involving wealth management and home or business financing options.

    We can have a job-creating economic engine that also delivers affordable care at a higher quality. It will just take some deep questions, a willingness to change, and the vision to understand what aspects of the system are worth preserving and which need to be addressed.

    The problem isn’t “fixing” the system

    We’ve created a booming sub-industry within health care dedicated to fixing the broken system. Everywhere you look, there are jobs and careers popping up around “fixing the problem.” The thing is, there’s a catch; it’s not really a broken system. It’s the perfect system—a system reacting perfectly to the market forces at play, human-made forces that are contributing to much of our nation’s economic stability.

    The problem with health care isn’t “fixing” the system. The problem is continuing to ensure that profits can be made and millions can be employed while better health care outcomes and experiences are achieved.

    We won’t find the solution to that problem by embracing the solutions offered by either the right or the left. We need to leave the past behind and start again, building a new health care system that better meets our needs. We have to build from the ground up, starting with a new foundation. I can’t wish away the political realities that stand in the way of such fundamental reform. But given all that’s at stake, I’m unwilling to accept anything less than this goal. Hopefully, you agree.

    Jeb Dunkelberger is a health care executive and author of Rich & Dying: An Insider Calls Bullsh*t on America’s Healthcare Economy.


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