The Wrong View Of The Right Problem
Stanley Feld M.D.,FACP, MACE
Most of the stakeholders in the healthcare industry are not stupid. Most understand the issues very well.
The problem is they all look at the same problem from the prism of their own vested interest. Each government action causes these stakeholders to react in their vested interest.
Each reaction causes a compensatory reaction from the other stakeholders, which in turn causes another chain of reactions.
The healthcare system becomes further twisted into a tighter non-functioning hairball that is more expensive than previously.
Aetna CEO Mark Bertolini was the keynote speaker at HIMSS14. His analysis was correct He said,
“Antiquated systems and out-of-control healthcare costs in the United States are not sustainable.”
He went on to say the healthcare system is plagued by inefficiency and waste.
“ We can’t afford it. It’s unsustainable.”
Employees are now paying 41 percent of their healthcare dollars to the healthcare insurance industry. It includes premium costs, deductibles, and copays.
These costs consume much of employees’ disposable income. Mark Bertolini predicts that employees will be paying 50% in 5 years as insurance premiums increase.
Mark Bertolini is really saying consumers will stop buying insurance soon. The result will be a decrease in Aetna’s profit.
All the stakeholders are at fault. Consumers are at fault for not taking care of themselves. The incidence of the onset of all chronic diseases increases with the incidence of obesity.
When there is an increase in chronic disease there is an increase in the complications of chronic diseases.
Eighty percent of the money spent on treating that chronic disease is spent on treating the complications of that chronic disease.
Patients must manage their chronic diseases under their physicians’ direction. The patient lives with that disease 24/7.
Patients must be taught to be the “Professor of Their Disease” so that they do not get a complication of that disease.
Patients must also be given financial incentives to become the manager of their disease. This incentive can be developed in many ways.
Reimbursement for education is not routine. There is little financial incentive for physicians to set up educational systems.
Hospitals at one time set up educational systems for chronic disease. They found them a financial burden and discontinued them. The educational systems did not distinguish one hospital from another.
The educational systems were not set up correctly. They should have been set up as an extension of the patient’s physician’s care.
I believe the healthcare insurance industry really wants to lower costs while retaining the profit margins enjoyed in the pre and post Obamacare era.
Aetna’s Bertolini got it right. “We can’t afford it.”
“If we really want to take care of people, we should align incentives around keeping them healthy.”
He is right. His problem is he thinks he controls patients and patient care.
The government thinks it controls patients.
Physicians know they do not control their patients’ behavior.
Neither the healthcare industry and government nor physicians controls patients.
Patients control themselves.
Bertolini said. "Recent data compiled by Aetna found that the top 5 percent of Medicare patients consumed 43 percent of Medicare dollars. They spent on average $108,000 a year per person."
The demographics of these patients disease including past and present lifestyle are not discussed in the data mining survey. This information would be helpful to know the true meaning of this data.
He then concludes, “Let’s not keep sending these people around with 25 different prescription and all these different doctors and hospitals.”
Who is the stakeholder sending patients to all the different hospitals and giving all the different prescriptions.
Physicians, of course!
Therefore, let us penalize physicians for spending all this money on our patients.
This is the wrong way to look at the problem.
If there was meaningful Tort Reform, physicians wouldn’t be doing so much unnecessary testing and treating to avoid missing something that could result in a malpractice suit.
If there were meaningful incentives for patients to be responsible for themselves people would stay healthy.
Patients should be responsible for their healthcare dollars not the government or the insurance industry.
People should also be rewarded if they stay healthy just as the auto insurance industry rewards drivers who do not have an accident.
If the government made a meaningful effort to change our eating habits through meaningful education much illness and medical costs would be reduced.
The center of the new healthcare system should be the patients. It should be a consumer driven system.
As soon as all the secondary stakeholders focus on that fact and start helping instead of penalizing patients and their physicians, the cost of the healthcare system will come down.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone
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