Healthcare needs a civil rights movement in which we reset our view of right and wrong.
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In the not too distant future, there will be a time when we look back with shame and embarrassment at the health system as it is today. We will wonder how anyone received the right kind of care and regretted the policies and clinical decisions that have made our system unaffordable, inaccessible, wasteful, and inferior to our peer nations.
To hear how some people discuss healthcare these days, the Affordable Care Act (ACA) established the healthcare system. But that’s not really true. The ACA expanded the tent and made health insurance coverage available to more people. But the tent poles now need to be replaced.
More than a decade since the ACA’s major regulations came into effect, America still spends twice as much on health care as other high-income countries, and yet we have poorer health outcomes, including the highest, compared to these other countries Avoidable Death Rate. Quality remains variable at best.
This is the 35,000-foot view of the U.S. healthcare system economy. It may be more instructive to get to the human level, where 21 million Americans with $ 46 billion in medical debt as of April 2021 face collections and half of all adults in the US fear a major health event could lead to bankruptcy in their household. Aggressive debt collection behavior is not just limited to nonprofits, but has spread to nonprofits, the actions of which have resulted in patients and families being brought back in endless litigation over their medical bills.
Unsurprisingly, wealth plays a large part in the American healthcare experience. Dr. Atul Nakhasi is the general practitioner at the Martin Luther King Jr. Ambulance Center in South Los Angeles. Atul trained as a physician at UCLA, located at 90095 zip code, and then worked across town at MLK (90059). That is not insignificant. Reversing these two numbers reveals what Nakhasi calls “two very different Los Angeles” and makes the difference between “whether you live to see your grandchild come into this world and take their first steps”. Eighty percent of the patients Nakhasi sees in southern Los Angeles earn less than $ 18,000 a year – what Nakhasi describes as “21st century uninhabitable income.” The differences in results between these two Los Angelesers were particularly pronounced in the pandemic – where infection rates and income cards appeared to work in inverse proportion.
This does not mean that the current system serves even the richest Americans very well. A study recently published in JAMA found that “the health outcomes of white US citizens living in the 1% and 5% richest countries are better than the average US citizen,” but those wealthy people are more likely to have a heart attack die or cancer, during childbirth or to lose a child than people in 12 other industrialized countries.
Let’s be honest Our health system is stupidly broken.
One of the causes of this brokenness is our tendency to intervene aggressively when chronic diseases become complicated – but do little to prevent or treat those chronic diseases in the first place. As I have already written, the American system – unlike that of our colleagues – leads to endless flows of money into expensive specialist visits, while at least 25 percent of people do not even have a family doctor. We easily send terminal diabetics to expensive dialysis and retinal surgeries – but pay minimal costs for general practitioners and programs to prevent diabetes from developing in the first place. Experts like to say we have a health insurance system, not a health system. I’d rather say that we have a sick system.
Some hitters in the American economy have tried to cure our sick system, notably Amazon, Berkshire Hathaway, and JP Morgan with their widely acclaimed Haven Healthcare company. Haven collapsed earlier this year, but many of us suspected from the start that it never stood a chance. Regardless of what his brilliant minds brought together, patients still had to be cared for in dysfunctional clinics and hospitals, take outrageously expensive drugs, and wait for clunky labs to run tests. Haven was trying to disrupt a system he was relying on at the same time. Without a major revolution, it is difficult to disrupt an existing care model.
Since the government regulators themselves were one, I have great confidence in their ability to develop, once a generation policies – like the ACA – that can enable innovation. But recently, policy makers have suffered the same lack of bold ideas as the leaders of our major health systems. Even when they create the right policy tools, such as demonstrations by the Centers for Medicare and Medicaid Innovation (CMMI), uptake and acceptance is often low. We need more courage and imagination in this area.
What does it take to bring about real reform in our system? I think of the civil rights movement that flourished in America after World War II. Looking at the horrors of Jim Crow, brave leaders saw a system that was a national embarrassment and called for reform. And so a movement was born and carried by a brave crowd of ordinary people who did not want to rest until they saw concrete change before their eyes.
We need a similar movement in healthcare. We need courageous leaders who will admit that our current system is an embarrassment. We need clinicians like Atul Nakhasi who understand that a little more common sense can heal people. We need employers who stand up and say they are no longer willing to put health benefits in the oven of lackluster results. We need insurers that focus on insuring low-income Americans and color communities and fighting for their members by demanding quality care at a fair cost.
Now is the time for leaders to emerge and we as a nation get involved in the same way that previous generations committed to the civil rights movement. Now is the time to work together to seek and find fundamental solutions to these problems.
Or we can ignore them and wait for our children to look back on us with embarrassment and shame.
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