By Wayne Caswell, founding editor, Modern Health Talk
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?
That cancer analogy pretty much says it all. Obamacare was a compromise reaction to the diagnosed problem, like an initial treatment; but opposition prevented it from rooting out the cause (insurance) and offering a real cure (universal healthcare). While other advanced nations see healthcare as a human right and offer universal healthcare, here we see it as a personal responsibility or a privilege that must be earned.
Our addiction to employer-provided health insurance began in WW-II when the government froze wages and employers needed an added benefit to attract workers. But insurance that functions as prepaid medical care more than providing financial protection against catastrophic illness or injury is why we continue to pay twice as much for medical care as other nations but still live sicker and die younger.
The Affordable Care Act, which passed under President Obama without Republican support, addressed many symptoms of our cancerous healthcare system, but follow-up legislation was needed to avoid remission. Unfortunately for us, Republican obstructionism prevented that, and it seems that many of the symptoms have now returned.
So our healthcare system is far from having a clean bill of health, and it’s because we haven’t been treating the whole patient. What’s scary is that there is no sign that Trump plans to do that either.
There’s no discussion of the underlying cause(s) of our systemic cancer, or of what kind of nation we want to be, how compassionate, or how to get there. That should be the starting point, with input from all stakeholders, including the patents.
There’s no talk of universal healthcare, just universal “access” to health insurance. Instead, the focus is on how to “pay” for medical care (mostly through for-profit health insurance), but what is lacking is respectful debate about how to improve the delivery system or avoid the need for medical care in the first place.
Obamacare encouraged innovative business models using technology to improve the efficiency & effectiveness of healthcare delivery. Examples include Accountable Care Organizations, the Patient Centered Medical Home, and electronic medical records Meaningful Use incentives. We’re already seeing improvements from watching big healthcare systems leverage technologies like remote sensor monitoring, telehealth video consultations, big data analytics, and artificial intelligence.
Those sitting at the top of the healthcare mountain are being forced to innovate, because they feel threatened by new competition from concierge and functional medicine clinics and others that are driving disruptive change. This is good, but the political system is still preventing a more-holistic approach.
Even Benjamin Franklin knew, “An ounce of prevention is worth a pound of cure.” But instead of stressing wellness and prevention, the US healthcare system is driven by a fee-for-service business model that unwittingly encourages consumers to make unhealthy lifestyle choices, and causes providers to view patients as paying customers and treat their symptoms so they keep coming back, paying. Obamacare made progress toward changing these misaligned incentives and business models, but more needs to be done, and going backwards by repealing Obamacare is unacceptable.
Public health officials have focused more attention on prevention than general practitioners have, and GPs more than specialists. These public health officials have seen differences in average longevity of more than 20 years between poor and affluent neighborhoods on opposite sides of the same city, according to the HBO documentary, “The Weight of the Nation.” While the documentary mostly covers the obesity epidemic, it also shows poverty as a primary cause. So, part of curing our broken healthcare system must be to address poverty and the widening wealth gap, because that’s where the cancer grows.
The more we continue to just treat the symptoms of our sick healthcare system, the more the costs will spiral upwards. And without aggressive, natural and holistic treatment, this unsustainable trend could take down our entire economy and country.
Healthcare is BIG Business (see infographic below), and industry special interests have vigorously opposed any meaningful reforms that threaten their $3 trillion/year revenue stream. They certainly don’t want to see revenue and profits cut it in half to match what other nations pay. So they spend more than three times as much on political lobbying as the military industrial complex and are behind Republican opposition to Obamacare.
From my perspective as founding editor of Modern Health Talk, I worry that health reform under Trump could make things worse unless he takes a holistic approach. But that would mean opposing the lobbyists and the Republican Congress that put him in office. It would also mean addressing poverty and income inequality with higher taxes on the wealthy to fund strategic investments. But Trump’s public statements, cabinet appointments, and personal history & DNA suggest that he’ll never do that.
NO QUICK FIX
Obamacare “repeal and replace” is easier said than done, and Democrats will resist just as Republicans resisted before. Some of the repeal can be done with a simple majority vote, but replacing the complex law is not possible without 61 percent of votes, and that will need some Democrat votes and will take a long time.
As I ponder the difficulty of reforming our complex and cancerous healthcare system, I think back to a 2011 presentation I saw by Dr. James Rohack. He shared his perspective as the past president of the American Medical Association from 2009 to 2010 during debates over Obama’s Healthcare Law and told us how Obamacare was modeled after a healthcare system that Mitt Romney successfully adopted in Massachusetts, which itself was conceived by the Heritage Foundation. But even with this conservative foundation, it took years of debate to pass the Affordable Care Act, because of Republican hatred of President Obama and their fierce opposition to everything he did. Expect similar Democrat opposition to President Trump.
HOW SICK IS OUR HEALTHCARE?
For an even better understanding of how critical the condition is, watch the feature-length movie, Escape Fire: The Fight to Rescue American Healthcare and this sarcastic look at what air travel would look like if it worked like healthcare.
Infographic Transcript for screen readers
With insurance premiums continuing to rise, a population growing increasingly divided on how to fix the healthcare system, and public health taking a backseat to corporate interests, many are losing their hope for a healthy future. Healthcare costs are spiraling out of control, but where does this unprecedented amount of spending go? See how your healthcare dollars are spent and take a look at the profits of some key players behind the healthcare scene.
HEALTHCARE: THE BIGGEST BUSINESS OF THEM ALL
- $1 out of every $6 spent in the U.S. is spent on healthcare
- $2.8 trillion in U.S. healthcare spending estimated in 2012, projected to hit $3.5 trillion in 2016
- At this rate, healthcare spending will account for 25% of the GDP by 2025
- 60% of bankruptcies in the U.S. are a direct result of overwhelming medical bills
- 3/4 of these bankruptcies are filed by individuals who have health insurance
ROUND & ROUND: TRACKING HEALTHCARE SPENDING
- Estimated annual amount of wasted healthcare spending: $765 billion. That’s 1/3 of healthcare spending.
- $210 billion is spent each year on procedures performed entirely out of fear of liability rather than need
- $10 billion: Estimated amount hospitals overcharge Americans each year.
- Where do our healthcare dollars go? (pie chart): hospital care, physicians & clinics, prescription drugs, dental & other, government administration, other, nursing & continued care, and investment
- 56%: Increase in insurance provider profits in 2009 [before Obamacare], during the height of the economic downturn
- 7 million: Number of Americans who could no longer afford coverage
- Premiums for small employers increased 180% between 1999 and 2009
- $390: Amount spent every second by healthcare lobbyists while fighting the healthcare reform bill in 2010
- 1,546: Number of healthcare lobbyists in D.C. That’s 3 lobbyists for every member of Congress!
- [Obamacare has flattened the curve to the lowest rate or cost increases in decades, but it has not yet reduced costs.]
KEY PLAYERS (% CHANGE IN PROFITS FROM 2010
- Insurance Industry
- United Health Group (11%)
- WellPoint (-8%)
- Humana (9%)
- Medical Facilities
- HCA Holdings (104%)
- Universal Health Services (73%)
- DaVita (18%)
- Pfizer (21%)
- Johnson & Johnson (-28%)
- Merk (629%)
- Pharmacy Services
- Medco Health Solutions (2%)
- Express Scripts Holding (8%)
- Quest Diagnostics (-35)
Infographic by BestHealthcareMBA.com