Why American Health Care is So Expensive

[Private] Health Spending as share of GDP

This video by Vox and Ezra Klein explains why American health care is so expensive, and it does so simply and effectively. It mentions each of the top issues I write about here at Modern Health Talk, including the political influence of a medical cartel that profits from treating illness and injury with a fee-for-service business model.

The video gives me an opportunity to highlight the many issues contributing to our high costs, with a short description and reference articles for each.

  1. There’s No Easy Fix
  2. Market Forces Don’t Work in Health Care
  3. A Medical Cartel Influences Public Policy
  4. Direct to Consumer Advertising Influences Public Attitudes
  5. Incentives are Misaligned with Goals
  6. Health is Not a Policy Objective but a Political Weapon
  7. Inequality affects Health Wealth, Opportunity & Influence
  8. Single-Payer is Not Enough
  9. Public Health Programs are Effective
  10. Medical Schools teach Diagnosis & Treatment, not Prevention
  11. Disruptive Business Models Break From Fee-for-Service
  12. Tech Solutions Define the Future of Healthcare
  13. Aging Populations Stress Support Systems
  14. Important Documentaries

Read More …

Shouldn’t Health be Primary

Health is PrimaryAmerica’s Family Physicians are promoting Health is Primary, a communications campaign that reflects the values of family medicine, puts patients at the center of their care, and aims to improve the health of all Americans, as well as costs. The Washington Post last week carried their sponsored article about A Health Care Solution We Can’t Afford to Ignore: PRIMARY CARE.

These physicians are apparently frustrated by Congress and partisan politics that is so toxic to our healthcare system, and our health. The United States is known to spend twice as much per capita as other advanced nations on healthcare, but with worse outcomes, so I’m happy to see this organization expand the debate beyond just how to PAY for care and who bears the burden. I’m glad to see their goal of actually improving wellness and care delivery, because even Benjamin Franklin knew that “An ounce of prevention is worth a pound of cure,” and that was two centuries ago. Read More …

A Public-Private Hybrid Healthcare System


American Healthcare is Going Public, and Private. (Click to read article)

I published this article back in 2012 but updated it now because Senators Bill Cassidy and Lindsey Graham just introduced a bill they aim to ram through Congress without a CBO score or public hearings. Senator Bernie Sanders also has an Obamacare replacement. It’s a form of Medicare-for-All, and it’s gaining wide support among Democrats and the public.

GOOD NEWS UPDATE: Republicans failed to get enough votes to pass the Cassidy/Graham bill.

As founding editor of Modern Health Talk, I think both sides need to step back from partisanship, look at the big picture, consider all stakeholders, look to other advanced nations for inspiration, and combine the best properties of each into a public-private hybrid healthcare model.

Is Health Care a Right? — Dr. Atul Gawande, a surgeon and public-health researcher, wrote an amazing article for The New Yorker that asks a question that’s been dividing Americans. His interviews offer important new insights that were missing in the Republican push to repeal and replace the ACA without a single public hearing. Not only do we need to understand what other nations do, but we also need to understand the different perspectives of our own citizens. This amazing must-read article is a good companion to my own article on Single-Payer. Read More …

Get the Health Incentives Right

Fixing our broken healthcare system, reducing costs, and improving care all comes down to getting the objectives and health incentives right.

Motivation - Fixing our broken healthcare system, reducing costs, and improving care all comes down to getting the objectives and health incentives right. This post is based on a comment I made when Pritpal Tamber called for “Creating a parallel system to health care” in MedCity News back in 2014.

At least for consumers, Modern Health Talk (www.mHealthTalk.com) can already be called the “Institute for New Health Thinking,” with well over 100 articles on Legislative, Public Policy, and Health Reform topics written for consumers, and over 700 on modern health topics in general.

I personally think fixing our broken healthcare system all comes down to agreeing on objectives and getting the INCENTIVES right, as I wrote five years ago when proposing a hybrid, public/private model of health care. The goal then was to exploit the different incentives of (1) capitalism and private sector organizations that measure success in business terms such as profit, ROI, and payback period, contrasted with (2) the public sector, which measures success quite differently and over much longer time periods.  Read More …

Fixing Healthcare – Searching for a Healthcare Unicorn

Fixing Health Care is more than Searching for the Healthcare Unicorn

By Brian Holzer MD, MBA, President, Kindred Innovations

[This blog post, originally published on LinkedIn, is based on my personal view and does not in any way reflect the opinions of the current organization I work for].

Last week I came across the article titled, “Cuts threaten rural hospitals hanging on by their fingernails” which reported that 673 rural hospitals were at risk of closing. The data came from the Chartis Center for Rural Health, which also cited that states including California, Oklahoma, Louisiana, Alabama, and Georgia were most at risk with as many as 79% of their rural hospitals facing possible closure.

Reports like these that imply an impending doom of the healthcare system, as we know it are almost a daily event. And the sensationalism of healthcare by politicians and the media only adds further distractions to a system that is starving for patience and unbiased pragmatism. There is also no shortage of articles professing solutions that say nothing more than we need to 1) create a system that ensures that everyone has access to health insurance; and 2) make sure that we contain the huge cost increases.

The real problem we are facing as a society is that Healthcare is a Unicorn…Healthcare is not the same as other markets. There is a widespread lack of transparency about both the costs and the effectiveness of treatments, and many other details that a customer or end consumer might use to make purchasing and utilization decisions in healthcare. If life were as simple as it is often taught in business school classrooms, fixing Healthcare should be as easy as learning from other industries and adopting best practices. So, let’s [apply lessons from] two industries-airlines and auto insurance. Read More …

A Single-Payer Healthcare System for All Americans

Will Fisher Explains Single Payer With Jelly Beans

Watch Will Fisher Explain Single Payer With Jelly Beans (YOUTUBE)

For most of us, getting healthcare in this country is way too hard, as the video at the end shows. So to those in Congress who would make it even harder, I say, “Keep It Simple, Stupid,” with a single-payer system providing universal coverage and healthcare for all.

Because so few people know what single-payer is, Will Fisher uses jelly-beans to explain it. To begin with, single-payer is NOT where the government employs the doctors and directly provides the care. That would be single-provider care.

Will’s jelly-bean analogy shows how we currently Pay for care and the savings from a single-payer system. But read on to see why even Bernie Sanders’ Medicare-for-All plan, doesn’t go far enough to achieve the far greater savings potential I so often write about.
Read More …

Influencing Healthcare Policy – Lobbying, Incentives & Insurance

Benjamin Franklin is credited as saying, "An ounce of prevention is worth a pound of cure," but policymakers seem more influenced by the money he's pictured on.

Ben Franklin said, “An ounce of prevention is worth a pound of cure,” but policymakers seem more influenced by the money he’s pictured on.

By Wayne Caswell, Founding Editor, Modern Health Talk

As President Trump’s administration transitions from the Obama era, a conservative ideological shift will influence healthcare policy, but so will other factors. They are discussed here, based on my response to “The Past, Present and Future of Healthcare Policy” at ReferralMD.

Influencing Healthcare Policy

Although The Patient Protection and Affordable Care Act, more commonly known as ObamaCare, has flattened the curve to the lowest annual cost increase in decades, it still has not reduced overall costs for many reasons. These include (1) special interest lobbying to protect industry revenues & profit, (2) misaligned incentives, and (3) an insurance middleman that adds more cost than value. It is unlikely that any “repeal and replace” strategy can live up to Trump’s promises because of these three factors. Read More …

US Healthcare System has Cancer. Can Trump Fix it?

By Wayne Caswell, founding editor, Modern Health Talk

Dr. Sudip Bose says, "The epicenter of health care is the doctor-patient relationship."

Opening his January 16, 2017 Huffington Post article, Dr. Sudip Bose said, “One thing is certain about the future of Obamacare, and that is that it will change under a Donald Trump presidency.“ Given his public statements, Trump will clearly make sweeping changes sooner than later, but what those changes will be is anything but clear. That’s why today’s article describes what I hope for, if not what I expect.

The US healthcare system has cancer – a malignant form that started way before Obama became President, and it has taken decades to grow to its current condition, where our very existence is threatened. It’s my hope (remember Hope & Change?) that healthcare reform under Trump will not just treat the symptoms of a growing healthcare cancer, like the lack of insurance competition or price transparency. I hope Trump will recognize the need to treat our healthcare system’s cancer aggressively, naturally and holistically. Will he? Read More …

Corporate Behavior and Rising Health Care Costs

If healthcare corporations and insurance companies are persons, as the Supreme Court’s Citizens United decision says, then what sort of persons are they?

Click the image to watch

As presented in this award-winning documentary, which you can watch below, the operational principles and legal requirement of a corporation to serve shareholder investment interests, give it a highly anti-social “personality.” Corporations are inherently self-interested (profit-driven), making them often amoral, callous and deceitful, even breaching social and legal standards to get their way. And while they can mimic the human qualities of empathy, caring and altruism, corporations don’t suffer from guilt and can’t be jailed. In short, modern corporations behave like a psychopath, and they use their political clout to avoid regulation and reform.

Free-market capitalism is no longer played on a level playing field, even in healthcare, because large corporations unfortunately invest in lawyers and paid lobbyists to gain political influence and craft laws in their favor. They can effectively “buy” elections with unlimited funds directed in secret to political action committees. Read More …

Disrupting Healthcare with Functional Medicine 2.0

Disrupting Healthcare with Functional Medicine 2.0

By Dr. Shaiv Kapadia, Chief Medical Officer and Co-Founder, Iggbo

The United States has the best and worst healthcare system in the world. Let me explain. If you are having a heart attack or stroke or a victim of an accident, there is no better integrated system of acute care delivery on the planet. Chronic disease, however, is a completely different story. [EDITOR: The medical industrial complex spends twice as much on political lobbying as the military industrial complex, to avoid disrupting healthcare as they know it. That’s because cutting costs to match what other advanced nations pay per capita would mean losing over $1.5 trillion/year in profits – profits that today mostly come from treating symptoms.] Read More …

Who Should We Believe about Longevity & Other Claims?

Who should we believe about how long we can REALLY live?Who should we believe about how long we can REALLY live?

Controversy and catchy headlines help sell magazines and advertising, and that makes writing about outrageous claims profitable. The more outlandish, the better. The news media loves it, and so do the readers, whether it’s political controversy or in how long we can live.

The LA Times, in When, and why we must die, is just one of the many news outlets to pick up a story about two scientists who recently published study results concluding that humans can’t live beyond age 122. They’re entitled to their opinion, but I don’t buy it. Read More …

The Big Heist – Become a Benefactor

The Big Heist, a satyrical documentary about our broken healthcare systemYou can be part of History by becoming a benefactor of The Big Heist, at any amount. This documentary-in-process is a satirical, follow-the-money film about healthcare, the status quo, and efforts to fix our broken system from the ground up.

The Big Heist blends the comedy & parody styles of ZDoggMD and The Daily Show — to entertain and educate with the goal of transforming the public’s understanding of our nation’s healthcare system, along with the causes of its dysfunction, and how to truly fix it. This has been my personal passion since founding Modern Health Talk five years ago. I’ve already published over 100 articles on different aspects of healthcare reform public polity, sharing my own technical & futurist perspective and insights, and I love hearing other viewpoints with similar aims. Read More …

The Future of Healthcare? It’s In The Past

The future of healthcare is impacted by the ripple effects of past developments, trends, market drivers, and market inhibitors

The future of healthcare is largely affected by politics and population health successes of the past, including vaccines, clean water, safe food, sewer systems, public education, and the environment, each causing its own set of ripples in the system. But dampening these positive effects is special interest lobbying aimed at protecting profits. (Wayne Caswell, mHealthTalk editor)

By Tim Perry, MPA, MS, CPHIMS, PCMH CCE, CISSP

Look Back to See Where We Are Going

To celebrate its 200th anniversary, the New England Journal of Medicine published an article in June 2012 titled, “The Burden of Disease and the Changing Task of Medicine“. The authors did a wonderful job of looking not only at clinical data on disease but also shed light on changes in society that affected the prevalence of diseases. A particularly interesting part of the article is a chart depicting the Top 10 Causes of Death in 1900 vs 2010. Notice the changes. Read More …

What to ask Clinton and Trump about Healthcare?

I responded to a Huffington Post article about proposed changes to Medicare and questions that should be asked of Hillary Clinton and Donald Trump, but I went deeper into the serious healthcare issues, citing an article I posted yesterday about The Ideal Healthcare System. It referenced differences between public and private sector organizations but primarily spoke of the need to better align incentives to the nation’s health goals. Therefore, my questions to Presidential candidates relate to that larger view of health and healthcare.

What to ask Clinton and Trump about Healthcare?

What would YOU ask Clinton and Trump about Healthcare? (please comment below and share with others)

Read More …

Let the Health Care Reform Debates Begin, Again

Let the Health Care Reform Debates Begin, Again

Click the image to see some of our other articles on public policy and health reform.

Editorial by Wayne Caswell, Founding Editor, Modern Health Talk

According to Forbes, House Republicans released this week a 37-page draft of their plan to “replace Obamacare and reform entitlements.” To that I say, Let the Health Care Reform Debates Begin, Again.

Even though Obamacare has slowed the rising costs of healthcare as our population ages, significantly more work needs to be done to bring our total costs in line with what other advanced nations pay, and with better outcomes. Doing that – continuing to reform health care – has the potential of cutting our $3.4 trillion/year costs in half, thus saving well over $1 trillion/year. Those savings can then be redirected to other purposes, such as lowering taxes, paying down debt, or making strategic investments in education, poverty, research, and infrastructure. The aim of such reforms is to help all Americans regardless of age, income, or socio-economic status.

But powerful opposition to true reforms comes from within the medical industrial complex that stands to lose over $1 trillion/year in revenue and so spends three times as much on political lobbying as the military industrial complex. It’s important that the public keep House Republicans from being tempted to cave into the lobbying pressure. So what should our goals be? Read More …

The Disruptive Force of Technology in Healthcare

A LinkedIn discussion of mHealth argued that, “Technology is Just a Tool. It’s Not The Solution to Healthcare’s Problems” — I couldn’t disagree more and posted this response…

Those in the Ivory Tower should worry about the disruptive force of technology in healthcareMy Editorial Opinion

Okay, Technology is not the end-all, but it’s MUCH MORE than just a tool for solving healthcare’s problems. The accelerating pace of tech innovation is a disruptive force that’s breaking business models and helping to move us away from the fee-for-service model that’s primarily responsible for Americans spending twice as much as those in other advanced nations for healthcare. (See Moore’s Law and the FUTURE of Healthcare.)

Those at the top of the healthcare mountain, especially those resisting more rapid adoption of disruptive technology, are most at risk of obsolescence. As noted in 101 Minitrends in Health Care, 429 of the original [1955] Fortune 500 companies are no longer in business today.

As medical devices keep getting cheaper, smaller, more accurate, and easier to use; more & more functions once associated with doctors in hospitals will move down-market toward consumers at home, office or wherever they are. Telehealth video calls and telemedicine sensor monitoring will extend across town, across state lines, and across international borders as payers (including Medicare) realize that medical tourism often offers better outcomes at less cost.

All of these trends will democratize healthcare, increase competition, and help move the emphasis away from sick care and toward health & wellness. As Benjamin Franklin said, “an ounce of prevention is worth a pound of cure.”

4 Paths to End of Life – one costs less than we thought

ANN ARBOR, Mich. — There are 4 paths to end of life, but last-ditch, high-tech heroic treatments and days in the hospital intensive care unit is NOT what makes dying in America so expensive. The common belief is that this is where we should focus efforts to spend the nation’s healthcare dollars more wisely, but think again.

4 paths to end of life - This chart shows that having multiple chronic illnesses is far more expensive.

A new study finds that for nearly half of older Americans, the pattern of high spending on healthcare was already in motion a full year before they died. That’s thanks to the care they received for their multiple chronic health conditions — including many doctor visits and regular hospital stays over the year, not just in their final days. Read More …

Why Medicare-for-All is Not Enough

Doctors Prescribe Single-Payer Health Care Reform

Doctors Prescribe Single-Payer Health Care Reform

Dr. David Himmelstein speaks at a news conference about the new Physicians’ Proposal for Single-Payer Health Care on the steps of City Hall in New York, May 6. Photo: Annette Gaudino

Well before Bernie Sanders entered the presidential race, a nonpartisan group of 39 leading doctors set out to fix the glaring problems in the Affordable Care Act (ACA, or Obamacare). The single-payer plan they proposed, essentially Medicare-for-All, has since been endorsed by over 2,000 physician colleagues and published in the American Journal of Public Health, according to this article in Huffington Post.

The HuffPost article generated lots of reader comments, and I just had to respond because this is the sort of debate I love to jump into. It brings together many different perspectives, especially those of consumers who too often aren’t heard from by politicians. Here’s a summary of my responses and answer to the question, “Is Medicare-for-All enough?” Read More …

Research Funding and Hope for Alzheimer’s Disease?

Is there hope for Alzheimer’s disease?

Can Alzheimer's be stopped? a NOVA broadcast

This past week NOVA aired Can Alzheimer’s Be Stopped? (watch below) The program covered research funded by drug companies as they race to cure Alzheimer’s disease and other dementias. The profit potential from discovering a breakthrough cure, as noted at the beginning, is well into the Billions. Sadly, a treatment without a cure may be worth even more. So hence the race, given the large and growing numbers of people affected and the devastating impact the disease has on them, their caregivers, and society. Read More …