Friday, March 6, 2015

The Great Health Care “Fix”

The Patient Will See You Now: the Future of Medicine is in Your Hands – Eric Topol, M.D. (Basic Books)

America’s Bitter Pill – Money, Politics, Backroom Deals and the Fight to Fix Our Broken Healthcare System – Steven Brill (Random House)

Reinventing American Health Care – Ezekiel J. Emanuel (Public Affairs Books)

A staggering amount of ink, paper, hot air and treasure has been expanded in a seemingly never ending debate over how to best improve the current state of the health care in the United States. Some have deluded themselves into buying into the fantasy that the Affordable Care Act, aka; Obamacare was the so-called magic bullet that would once and for all fix the deeply flawed, ridiculously overpriced U.S. Healthcare system.

Unfortunately those delusional folks couldn’t be more wrong; the Obamacare legislation is the worst example of how Congress creates new laws, a mish mash of bad sausage making that slaps together so much contradictory information into a greasy mess of differing constituencies, that does nothing to actually improve care for the patient or lower costs for that sub-par care.

So despite decades of chatter, hand wringing and debate we really haven’t moved the ball. Three new books attempt to tackle the problem and at times bring strikingly similar points of view to bear and at others approach things from diametrically opposite perspectives. In the end only ones comes close to what will actually bring an impactful change to healthcare, albeit one that still has some hole that remain to be filled.

Dr. Ezekiel Emanuel, a physician and bio-ethicist by trade, was one of the architects responsible for the sloppy sausage making that went into Obamacare. His take on fixing healthcare comes in the form of his book Reinventing American Health Care, which is a mix of a clearly misplaced, misguided victory lap for his work on Obamacare and what he envisions as the next steps to continue that process.

Emanuel is a glaring example of a socialized medicine, universal healthcare-type who buys into the belief that government control is the only correct path to the delivery of healthcare. Its sounds like a case of, Obamacare was a good first step, but there is still more work to be done.

Emanuel makes some downright astounding predictions about what he sees as the future of healthcare, including:

·         The end of insurance as we know it – happening by 2025

·         The end of employer sponsored health insurance – happening by 2020

·         The end of health care inflation – happening by2020

·         The emergence of digital medicine and the closure of hospitals – happening by 2020

While I believe some of these predictions, which may be seen as bold by some, will likely happen, it won’t be for the reasons Emanuel lays out. Clearly Obamacare has failed miserably on one of the cornerstone claims that was made about it; reducing the cost of healthcare and health insurance. In fact, costs have continued to not only increase, but increase dramatically. Those costs will make it impossible for businesses, big and small, to continue to provide/underwrite the costs of insuring their employees.

As to ending health care inflation, this one is laughable on its face for a multitude of reasons. The most basic reason is one of the fundamentals of understanding economics, which clearly Emanuel and many in the Obama administration, including the President, don’t quite grasp; supply and demand. We are on the leading edge of aging baby boomers starting to hit the age where they we see the need to utilize health care at a greater rate, thereby increasing the demand, while the supply; doctors, nurses, etc., has remained relatively stagnant or actually decreased; which will lead inevitably to increased costs.

It is only with the emergence of digital medicine that Emanuel comes close to a correct prediction. Dr. Eric Topol delves much more deeply into the impact of the technological evolution and digitization of health care; more on that later.

Journalist and as he makes clear, a broad range participant in the health care system, Steven Brill takes a swing at improving health care by pumping steroids into his already pumped up take on the U.S. healthcare system. Brill expands on his epic 2013 Time magazine article, the 40,000 plus word piece entitled Bitter Pill – Why Medical Bills Are Killing Us, in the form of his new book, America’s Bitter Pill – Money, Politics, Backroom Deals and the Fight to Fix Our Broken Healthcare System.

Like Topol and Emanuel, Brill serves up a heaping helping of heart rendering stories about seemingly ordinary, average, American citizens who have gotten caught up in the staggering costs of the U.S. healthcare system. Anyone who has had a hospital stay or had a family member have a hospital stay to battle disease or illness, simple or complex, has been the recipient of a mind-numbingly complex, nearly impossible to read, let alone understand, medical bill. Depending on the type of illness and course of treatment rendered, maybe more than one bill.

These sob stories have the desired effect; outrage at the high costs involved and a backlash against a seemingly secretive medical industrial complex. Brill’s solution to the problem involves the creation of large, regional health care systems being formed and assuming the role of not only provider, but of insurer for the patients they treat. This model is currently being explored in Western Pennsylvania by the University of Pittsburgh Medical Center (UPMC) and it’s insurance division. The logic Brill provides is that the insurance arms would keep close watch on the providers and the providers would be loathe to overcharge or over treat the patients covered by the insurance side, thereby keeping costs in line.

The glaring flaw in both Brill’s plan and in that of Emanuel’s socialist approach is that both keep the person purchasing the health care service outside the loop of the decision making process, which is what got us into the position that we find ourselves now firmly locked.

The only author who comes close to actually getting to what will fix the problem with our healthcare system is Eric Topol, M.D., a practicing cardiologist and researcher. In his new book, The Patient Will See You Now: the Future of Medicine is in Your Hands, Topol correctly raises the question, “Is there any other walk of life when services are purchased, but the purchaser does not take ownership?”

The problem stems from the simple fact that the patient, the reason for the service in the first place has been marginalized out of the process by third party insurers and by medical providers. Until we return control of the purchasing decision back to the patient, then the U.S. health care system will continue to be a nightmarish maze of high costs, relatively lousy results and endless problems. With that control back in the hands of the patient/consumer, comes competition for health care dollars and with that competition will come a combination of lower costs and improved service/care.

Brill and Emanuel would prefer to keep control in the hands of a third party who dictates not only what care looks like, but where you can receive it, and how much of it you can receive.

Topol makes the case that it is unlikely that the current system will willingly make the choice to hand control back to the consumer, but it is more likely that the consumer will seize control through the means of digital tools that continue to evolve and become more readily available to the average consumer in the form of smart phones and applications.

While those tools will help consumers to jump back into the process, there is still a role for physicians to play in the prescribing of medications and delivering care not in the traditional hospital setting, but on an outpatient basis which renders another level of control back to the patient. It’s not so much a case of self-medication as it is a better informed consumer making better choices for their own care.

Topol also makes a strong case against what I can only call lazy medicine with doctors doling out meds by the bucketful. Topol spells out in detail the outrageous use of medications, notably the multi-billion dollar scams for things like attention deficit and hyperactivity disorder (ADHD) with over $9 billion in prescription drug sales annually and the anti-depressant prescription marketplace, which racks up tens of billions in sales on an annual basis, with most recipients of the meds not meeting even the most basic of medical need for the drugs. It’s doubtful that the real costs of the societal and medical impact of the reach for the prescription pad, better life through chemicals mindset, could ever be truly measured.


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