I’ve dedicated 15 years (and counting) of my life to contributing to the creation of a healthcare system that respectfully, equitably, and affordably provides timely care to every person who needs it. Since I began working in healthcare, I’ve led innovation, health equity, community health, communications, product/service design, digital health, value-based care, and clinical technology integration teams, strategies, and programs for insurers and integrated health systems and created their consumer content and marketing. I’ve loved the people and their commitment. Some of the work was amazing. But, as I sit here today—as the healthcare system continues to consolidate, patients, consumers, and primary care providers suffer, and we’re all doubling down on some version of the same strategies—I no longer believe any of it will fix what’s broken in American Healthcare.
Before you disagree, ask yourself these few questions.
- Is health care affordable for the average working person/family in America?
- In spite of hundreds of programs and campaigns, have we achieved health equity by any measure?
- What is the ratio of dollars spent to cost savings achieved when you tally up what you’ve spent on consultancies’ PowerPoints and Mural maps, startups’ apps and automation, tech companies’ cloud “infrastructure” and analytics, hospital rate increases, and fee-for-services firms that wrap around care for which you’ve already paid?
Now, consider this.
Healthcare is too expensive.
- 83M people (43M who have health insurance) skip appointments, lab work and don’t fill prescriptions (Commonwealth Fund)
- 65% of bankruptcies involve medical debt.
- 50% of adults in America can’t afford a surprise $1000 bill but the average deductible for an employer sponsored plan is $1434 ($2825 for a Marketplace plan)
- Total premiums for family coverage increased by 43%, workers’ share by 41% (2012-2022)—but wages grew by only 31% over the same period (KFF.org)
- The rising price of health care—not an increase in utilization—is responsible for two-thirds of per-person medical and pharmacy claims spending growth between 2015 and 2019
Health Equity does not exist.
Black, Hispanic, and AIAN people fared worse than White people across every health and health care measure:
- Having health insurance
- Receiving mental health services
- Flu vaccination
- Life expectancy
- Maternal & child mortality
- Health screenings
Healthcare professionals are leaving (even dying) and care sites are closing.
- 334,000 healthcare providers quit in 2021
- 20% of current providers say they intend to leave due to burnout and frustration at not being able to spend time with and treat patients in accordance with their medical training and oath
- 1 in 10 physicians have suicidal thoughts or have attempted suicide—300-400 die annually
- 1,887 acquisitions between 1998 and 2021 have led to 2000 fewer hospitals, higher prices, and no significant quality improvements
Health insurance offers little assurance of care.
- Due to multiple lawsuits, private insurance may no longer cover preventive care
- Lawsuits, restrictive new laws, and consolidation restrict insurance coverage of abortion, birth control, and gender affirming procedures
- See Healthcare is too expensive
Spending too much time and money justifying and propping up the model.
- Hospitals spend $5.6M, 108,500 personnel hours annually on quality reporting
- Physician practices spend $40,000, 785 hours annually ($15.4B in aggregate) on quality reporting
- Providers and payers spend $496B on insurance and medical billing costs
- Annual administrative spend/% of spend: Hospitals ($250B/26%), physician groups ($205B/22%), private payers ($180B/19%) and payers ($80B/9%)
- The U.S. government collected more than $26.8B in healthcare-related civil settlements and judgments from 2013 to 2022
- Physicians spend 16 minutes, 14 seconds per 15-minute patient visit in the EHR
And that’s just scratching the surface. I won’t pretend to have the perfect solution. However, I do believe that much of the solution lies in empowering individual physicians and providers—independent of, but partnership with, insurers, hospitals, health systems, and employers to make medically appropriate decisions—and in empowering and enabling consumers to directly purchase and utilize (not just have access to) affordably priced, timely, high-quality care from those who deliver and will be accountable for that care.
If you’ve got a solution, what aspects of that solution make it a fix for what’s broken in the healthcare system?