This month we’ve been publishing essays by health care leaders about improving the system. They were asked: Now what? With repeal-and-replace shelved for now, what should be done to improve the health care system for patients, communities and health care organizations? What’s right? What’s wrong? What needs to be fixed and what needs to be left alone?
Our health care system is a Rube Goldberg machine: Complicated, with lots of parts moving in different directions, producing unpredictable, frustrating results.
Some of the parts are well-designed and produce great outcomes. We have amazing medical research in our universities and hospitals. The Puget Sound region is a leader in discovering new drugs, treatments and devices that save lives. We must preserve the environment that makes the area an innovator in health care.
This is also a healthy place to live. Compared to the rest of America, we eat better, exercise more, and weigh less.
So we’re healthier, and our health care costs are lower than the rest of the country.
Our community has seen consolidation of big players, and the entry of large corporations.
Providence assumed control of Swedish — it’s one big system. DaVita, a for-profit company, purchased The Everett Clinic. Kaiser Permanente took control of Group Health. Consolidation can lead to efficiencies of scale. Elsewhere in the country, consolidation has led to increased costs and decreased choice. We need to guard against that.
Medical informatics is a disaster. Electronic medical records (EMRs) are a part of doing business. They are clunky, time-consuming and do not talk to each other. They keep doctors and nurses away from their patients. They are expensive. They don’t transfer data from one EMR to another. Despite the cost, time and frustration, EMRs do not improve health outcomes. The Steve Jobs of EMRs has not yet been born.
The payment system is broken. Reimbursement to hospitals and providers has not kept pace with inflation. But pharmacy and device costs have skyrocketed. We’ve allowed health care costs to be corrupted by lobbyists. There have been a few big winners, but increased costs for all.
The Affordable Care Act needs repair. The exchange products are too expensive and underutilized. More folks are insured, but at costs too high for poor insurance coverage. Our patients do not receive the coverage and service they deserve.
The folks who are supposed to coordinate all of these parts of the machine are failing. Our government has been stymied by the inability of Democrats and Republicans to accept good ideas from across the aisle. That has caused disorganization, corruption and inefficiency. Shame on our elected officials who can’t do the right thing because of politics and dogma.
Some believe in a single payer. Medicare for all! Unfortunately, D.C. is a cause of the current problems in health care. It would be politics as usual, and there is no reason to believe that the result would be better. There are better options.
In the Puget Sound area, we have some innovative models for health care insurance being developed. Starbucks implemented its own health care exchange and has been able to lower its health care costs and improve employee satisfaction. Microsoft is helping its employees be wise consumers by funding Health Savings Accounts and giving the employee control to spend or save. Boeing is struggling to rein in its costs. These models have a common thread of putting more control in the hands of the consumer.
Our health care machinery can produce outstanding results, but it is too inconsistent and expensive. That’s because it lacks a good pilot. The government should lead, but D.C. isn’t working right now. Innovators in the private sector might lead the way to a better future, but the roadblocks make that possibility unlikely today. The path through the red tape, politics and technology is uncertain.
The default settings too often produce complexity, frustration and increased cost, without producing optimal care. It is becoming clear that the pilot should be the health care consumer. Giving the consumer more choice, more financial control (and risk) has been shown to lower costs, deliver the care that the consumer wants and improve satisfaction.
Most of us have choices. There are multiple Medicare options available. In our community there is a wide range of innovative health care delivery systems, from narrow network HMOs like Kaiser, to fully independent groups like Western Washington Medical Group.
My advice is to put the work in to understand the different models. Don’t trust the experts who won’t know your family’s circumstance. Spending more is no guarantee of better care. Make the machine work to address your needs. You could wind up with more money in your pocket and better care. Make the choice that is right for you.