Ask the Right Questions about Healthcare

Politicians Need to Ask the Right Questions about Healthcare (Photo credit:

By Wayne Caswell, Founder of Modern Health Talk

Politicians Need to Ask the Right Questions about Healthcare

In Healthcare: Mandatory Coverage or Universal Access?, Dr. Josh Luke presents one perspective – that of a hospital CEO. Readers should know that he represents the medical industrial complex, which also includes insurers, drug companies, equipment providers, and testing companies. Their collective interest is to protect the perverse profits that come from illness and injury, and the fee-for-service incentives that encourage ongoing treatment of symptoms. I found Dr. Lukes’ framing of the healthcare issue too partisan, so I had to respond. My responses form the basis of today’s posting.

What’s the DIFFERENCE between Universal Healthcare and Universal Access? Republican politicians have promoted Universal Access, confusing it with Universal Healthcare. Access, however, only means you can get health care if you can afford it. That’s like having the ability to buy a luxury yacht or summer home, but only if you have enough money to afford it. Progressives instead want Universal Healthcare, a concept I endorse here at Modern Health Talk. It’s efficient and what other advanced nations have. So let’s reframe the issue by asking different questions. Declaration of Independence starts with We The People

Is BASIC Healthcare a Right, or is it a personal responsibility?This is a good starting point, because The Preamble to The Declaration of Independence says…

We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.

How much health care should GOVERNMENT (taxpayers) provide, and how much is an individual’s responsibility? This too is a good question, because Congress keeps tinkering around the edges of how to PAY for care through health insurance, and Dr. Luke’s article is no different. If we say government should pay nothing, then how do we prevent disease and pandemics if some people can’t afford immunizations and preventive care? Living in gated and quarantined communities is not a solution, because disease can propagate through air & water or from insects & animals? Public health officials understand that and have entirely different perspectives than that of hospital administrators or large medical corporations. They hold another truth to be self-evident, that…

An Ounce of prevention is worth a Pound of cure. (Benjamin Franklin)

How should we PAY for healthcare? Conservatives would have you believe they’re being fiscally responsible, but their political aim seems to be more about maximizing industry profits than reducing overall costs and developing a healthy & productive workforce. Meanwhile, their repeal & replace strategy would have resulted in huge tax cuts for wealthy elites while leaving tens of millions without health care because they can’t afford it.

Why should healthy people pay ANYTHING for unhealthy people? Some people oppose universal healthcare because they don’t want public help of any form to go to people who don’t work hard enough, don’t have enough determination, don’t make enough money, or are just “Losers” and don’t deserve it. It’s one thing for them to say they make good lifestyle decisions and others make bad decisions, but good decision-making is just one factor that determines their health. Luck also plays a role, and that’s why we have insurance — to spread the risk.

How much FOCUS should government put on wellness? I’m with Franklin on this issue and often write about prevention and the pillars of health: nutrition, exercise, and sleep? That’s why I urge everyone to watch the “must see” documentary, Escape Fire: The Fight to Rescue America’s Healthcare. It can be described as An Inconvenient Truth for the healthcare debate. I’m also working on a white paper, The Economic Benefits of Population Sleep Wellness, where I’ve so far estimated savings of up to $1 trillion/year from good sleep improving health, safety and performance. It will also suggest various public- and private-sector programs to improve sleep. Watch for it.

What PERSPECTIVES are most important? Politicians can’t be expected to understand all the nuances of the complex healthcare industry. They will naturally seek guidance from industry experts, and that’s natural. But problems occur when other perspectives are ignored or discounted. I give “We The People” (consumers, patients & voters) the highest priority in developing healthcare policy, followed by individual practitioners (docs & nurses), public health officials (who function as public servants and have no profit motive), and finally the medical industrial complex (large insurers, hospitals, drug companies, testing companies, and equipment providers).

What should be the OBJECTIVE of healthcare policy? Is it to serve The People and contribute to a healthy and productive workforce that drives the economy and global competition, or is it to maximize industry profits? We know what it SHOULD be, and I think we also know reality.

How does the U.S. compare with other advanced nations in the OECD? Many sources, including the United Nations and World Health Organization, report that Americans pay about twice as much but still live sicker and die younger. Our reliance on employer-provided and private insurance is the primary cause, or at least a major contributor.

Where’s the transparency? We may take great pride in free-market capitalism, but how can we expect people to shop for the best value in healthcare when hospitals keep their charges secret? Even if price transparency gave them the ability to compare options for common procedures, they’re unable to do so in emergencies when they’re unconscious or in severe pain. Capitalism just doesn’t work in healthcare, or at least not all the time. That’s why years ago I recommended a hybrid approach to blend the best qualities of public-sector organizations and the private sector.

How bad is the Affordable Care Act? Despite what you hear from conservative sources, the Affordable Care Act (Obamacare) made significant progress toward improving the accessibility, affordability, and quality of health care. Yes, it’s far from perfect, but fixing what’s broken is better than repealing it. The uninsured rate has declined by 43% since the ACA became law (from 16.0% in 2010 to 9.1% in 2015). And the cost curve was flattened to the lowest annual increase in decades. But still, overall costs have not been reduced. That’s for many reasons, including (1) special interest lobbying to protect industry revenues & profit, (2) incentives that are misaligned with goals, and (3) an insurance middleman that adds more cost than value. President Obama shared his perspective of successes, challenges, and important next steps in an article published last year in The Journal of the American Medical Association and posted here.

What about the Republican plan? Is there one? Republicans have long wanted to repeal Obamacare, but dozens of attempts have failed so far, including the recent American Health Care Act. According to the bipartisan Government Budget Office (GBO), tens of millions of Americans would have lost their insurance under that plan, because they’d be unable to afford it, and, tens of thousands of them would then die needlessly. So it’s no surprise that 85% of voters were angrily against it and wanted their representatives to instead fix the ACA problems. Isn’t it time that politicians find ways to reduce the need for health care in the first place through WELLNESS programs and focus less on shifting the funding burden and more on lowering overall costs? That could be done with innovative technology and disruptive business models.

Fixing U.S. Healthcare

With the right objectives, questions, and policies, we “should” be able to cut costs in half by curing our healthcare system’s cancer rather than treating its symptoms. That would save over $1.5 trillion/year, which could then be invested elsewhere. But will politicians have the COURAGE to stand up to industry lobbyists who spend three times as much as the military industrial complex to avoid losing that revenue?

UPDATE: The medical-industrial complex reportedly has spent $5.36 billion since 1998 lobbying in Washington. That’s even larger than the $1.53 billion spent by the defense and aerospace industries and the $1.3 billion spent by the oil and gas corporations over the same period.

As a futurist, I consider different scenarios, as well as drivers and inhibitors. I’m guardedly optimistic about the future of healthcare, because the opportunity and public awareness is so great. On the other hand, I worry about the politics, and that’s why this website gets political sometimes.

Universal Healthcare Justification

COSTS — Sure, some people will rile against government bureaucracies, but a single-payer healthcare system, offered universally, has been proven over and over to cost less overall than employer-provided or private insurance. Medicare is a good example. It comes out far ahead of the 2nd most efficient insurer, Aetna, and that’s why so many people have called for Medicare as a public option, leading to Medicare-for-All.

BENEFITS — Public health officials know about the prevention benefits of immunization, clean drinking water, and public education programs. But other benefits include improved productivity, which translates into improved profits, GDP, global competitiveness, and even national security. We need healthy soldiers, don’t we?

Isn’t Medicare an Entitlement?

No, not really. Conservatives ideologically hate entitlements, but Medicare is something that people pay for. It’s not something given to them. The same goes for Social Security. Seniors of retirement age paid into Social Security their entire lives, and they now pay for Medicare through deductions from their Social Security checks.

As a fee-based public health program offering basic services, Medicare is considerably more efficient than any private insurance company. That’s partly because there’s no profit motive. So why not offer Medicare as a public option, moving toward Medicare-for-All? Just as with Medicare, if people want more coverage options, they can always spend more for Advantage and Supplement programs. Is the only argument against this a perceived need to protect insurance company profits? How is that justified?

But what about people who can’t afford Medicare premiums? They may have no income if they’re in school, are in between jobs, have a temporary or permanent disability, etc.? What government help might they get until they’re back on their feet? I wrote two articles relating to that issue. One is on Universal Healthcare opposition, and the other is about the eventual need for social programs for the long-term unemployed as automation replaces jobs faster than creating new ones. The United Nations recently warned nations to prepare now, because that day is coming sooner than most people realize. They floated the concept of Universal/Unconditional Basic Income.

Telehealth and Remote Monitoring Technologies

I see a very strong future for telehealth companies and doom for those who resist. That’s because telemedicine improves employee health, lowers healthcare costs, reduces absenteeism, eliminates the need to take time off for doctor visits, and improves overall worker productivity. All of that contributes to employer’s bottom line, so it’s not surprising that more companies are supporting telehealth services, just as they supported in-facility services from companies like HealthSpot.

Protectionist lobbying and legislation, mostly with false concerns that telehealth risks patient safety, are being discredited left and right. And an increasing awareness of telehealth benefits, among with growing public pressure, is challenging those laws. Telehealth is now even extending across state lines. As it expands beyond care delivery to also support health, wellness & prevention, I expect telehealth to eventually extend across international borders too.

Telehealth and private pay are trends that are partly driven by more consumers opting into high-deductible insurance policies and taking responsibility for their health maintenance costs. They’re becoming more aware of the need to make healthy lifestyle changes and are seeking better value in healthcare. They’re also demanding that hospitals open up their once-secret charging system so they know ahead of time what procedures will cost and can actually comparison shop. All of this fuels my telehealth optimism.

2 thoughts on “Ask the Right Questions about Healthcare


    The Art of Repeal — Republicans’ Health Care Reform Muddle (interesting perspective in New England Journal of Medicine)

    How Telehealth Platforms Will Reshape U.S. Healthcare Delivery (Huffington Post, I commented)

    The telehealth future is not just in your pocket but also under your skin and in the cloud. Most smartphone benefits today come from the connection to cloud services. Soon that will also include connections with sensor devices that are worn, implanted or ingested, or sprinkled throughout our environments (hence the Internet of Things). Healthcare will help drive IoT and Artificial Intelligence, because measuring vital signs and biomarkers in real time adds context and enables electronic coaching.

    AI will improve over time as computer systems learn to measure their own effectiveness and work to improve by discovering new associations and health risk-factors to track. As they learn how different types of nutrition, exercise, and sleep affect health, they’ll also become effective coaches and encourage lifestyle improvements.

    Now extrapolate these AI possibilities at the exponential pace of Moore’s Law, and imagine AI helping lawmakers and government agencies craft public policy with population health-impact analysis. For more on the health implications of Moore’s Law and how computing’s future blends with science (Info + Bio + Nano + Neuro), see

    As founding editor of Modern Health Talk, I’ve written many articles on telehealth, but I’d like to share this one from 2.5 years ago that includes a video that shaped my vision:

    The GOP’s problem on health reform is they’ve spent years hiding their real position (VOX, I commented)

    Republicans in Congress still have time to honor Trump’s campaign promise to replace Obamacare with a healthcare system that covers everyone with much better care at far less cost, but they must swallow their pride, ask different questions, and consider Universal Healthcare (not Universal “access” to health insurance).

    Start with, “What REALLY is behind Republican opposition to universal healthcare?” It sure seems like it’s a fear of helping “LOSERS”. See

    Robert Reich also shared his views about why Republicans want to repeal Obamacare, and I expanded on them in

    Many other recent articles on Modern Health Talk address the issues of public health policy and health care versus health insurance, so I encourage you to check them out too.

    Crucial questions for a population health strategy – “As difficult as HOW can be, WHY is even more powerful.” – Michael W. DeGere, M.D.


    American Health Care Act, a Summary & UPDATE – The nonpartisan Congressional Budget Office says the AHCA (Trumpcare) would cause 24M people to lose health insurance by 2026, and as a result tens of thousands would likely die needlessly. Trump care 2.0 is said to be even worse.

    Let the Health Care Reform Debates Begin, Again – This was my editorial reaction to GOP’s draft repeal of the ACA.

    People Like the ACA, so it’s hard to Repeal. Here’s why. – Here are 12 reasons people like the Affordable Care Act (ACA is also known as Obamacare), along with detail in supporting charts that compare it with the Republican’s American Health Care Act (AHCA).

    Escape Fire: The Fight to Rescue America’s Healthcare – Features an EXCELLENT documentary film

    US Healthcare System has Cancer. Can Trump Fix it? – It’s my hope that Trump will recognize the need to treat our healthcare system’s “cancer” aggressively, naturally and holistically. But will he? Can he? Here are the challenges he faces.

    Universal Healthcare Opposition – What’s REALLY behind universal healthcare opposition? It seems to be an ideological fear of helping “LOSERS”.

    Why Republicans Want to Repeal Obamacare – Former Labor Secretary Robert Reich dives into what is driving repeal efforts, but he fails to mention the demographic shifts that threaten GOP political control, and how allowing tens of thousands of people to die without health care would benefit them.

    Influencing Healthcare Policy – Lobbying, Incentives & Insurance – Healthcare reform, whether it’s Obamacare or Trumpcare, seems to be influenced largely by these three factors to maximize profits.

    Chipping Away at Healthcare Special Interests Yet? – Revenue growth in the healthcare industry, driven largely by the corrupting influence of political lobbying, is unsustainable. Real health reform needs to resolve the conflicting motives of the public sector and private sector.

    HEALTH or SICK Care? – Unfortunately, fee-for-service healthcare incentives caused medical schools to focus almost entirely on diagnosing and treating illness and injury, not preventing it. Prevention goes against the business model of profiting from each patient’s visit, test, prescription and procedure – a model with the perverse incentive to do more and more, and charge more.

    Why High Medical Bills Are Killing Us – In his 38-page TIME magazine special report, “Bitter Pill: Why Medical Bills are Killing Us,” Steven Brill dives into our health care system to understand why things cost so much. Unfortunately, this important article is now behind a subscriber paywall, so I posted a summary and video introduction by the author.

    The Unbreak Campaign – This MD-driven Declaration Of Independence seeks answers to the same questions I ask in the above editorial. One of the leaders of this movement is ZDoggMD, probably the ONLY healthcare speaker/rapper ever, who uses his gift of sarcasm to educate the public on important issues.

    Disrupting Healthcare with Functional Medicine 2.0 – Healthcare is shifting from a Blockbuster’s bricks & mortar model to a Netflix on-demand, anytime/anywhere model. What we desperately need is a new “operating system” for healthcare that is predictive, preventive, personalized and participatory.

    Why Medicare-for-All is Not Enough – Beyond just improving the efficiency of how healthcare is paid for and adopting the exceptionally efficient Medicare system for everyone, we need to address the NEED for medical care in the first place, with incentives that focus more attention on overall health and wellness.

    Wealth Inequality, Healthcare and the Economy – People, including Congressional Republicans and Democrats, have little real understanding of how wide the wealth gap has become and it’s impact on healthcare and the economy, so this article features an excellent video infographic on the topic and other statistics.

    Corporate Behavior and Rising Health Care Costs – The aging population adds to healthcare costs but is a global problem, so what makes our healthcare system the most expensive in the world by far and without the positive outcomes to justify it? I see problems with our politics, special interest lobbying, and societal beliefs. And I find it telling that public health officials can accurately gauge one’s average weight and BMI by zip code, and that longevity in poor neighborhoods can be over 20 YEARS LESS than in affluent neighborhoods on the other side of the same town.

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