10.200.6.1 | Hi everyone, Thanks for all your comments generated by the PBS film, Healthcare: The U.S. vs the World. Thanks for your contributions and the spot on points made. I will provide individual feedback on your PBS blogs later. For now, here are my 2 cents worth of comment! While Switzerland’s unemployment rate is higher than the U.S. rate right now, it is mostly because the European economy was hit harder by the latest inflationary spiral than ours was. However, I think, as a small, relatively wealthy, and homogenous country, most Swiss can pay for their own health insurance during this downturn. And the Swiss do subsidize health care for those whose income is below a certain minimum threshold. Every Swiss has health insurance and so the key advantage of such a system is that it avoids the cost shifting that is responsible for driving up costs in our system (about 20-30 million uninsured). In addition, most European countries (including Switzerland) already had robust social safety nets in place and were ready to buffer their citizens against some of the effects of COVID. We almost achieved universal health care coverage by ramping up our social safety net and expanded ACA coverage in response to the pandemic. We also expanded child tax credits so families with kids under 18 could make sure food, shelter, and health care were being taken care of. Note, that now that the pandemic has been declared “over’ those policies have ended. And do not forget that employment based health insurance comes at a cost. As Emanuel and Fuchs point out “Employers do not bear the cost of employment-based insurance; workers and households pay for health insurance through lower wages and higher prices. Take a look at the article, “Health care financing and the sustainability of health systems” under the Chps 5_6 module. The authors argue that capital (producers) and wage income (employees) alone are becoming insufficient to cover rising health care costs. So, we may need to rethink how we financially support the health care system. We may need to consider a national health insurance system (Medicare for all?) as exists in other societies. And if as has occurred before, folks go ballistic about “going socialist” remind them that there is no better example of socialism in America than Medicare and social security! And why does our health care system have to cost 3 trillion dollars per year? Look at the health care spending table in the same module and find that about ¼ of that spending is just pure waste! That is about 750 billion (“with a “B”) dollars per year we flush while running our health care system. Surely, we can reduce that by lowering administrative costs and by eliminating a big chunk of fraud and abuse! But returning to the socio-political structure we inhabit; we have to recognize it is not receptive to wholesale systemic reform and that is why change in the system is rather incremental. Another reason is that there are vested interests such as health insurance companies and big pharma who bristle at the idea of losing their “cheese” and put up a lot of resistance through their political lobbyists in Washington D.C. The AMA is also guilty of this practice but there is hope on the horizon as today’s incoming physicians tend to be more socially conscious and understand the benefits of emphasizing primary preventive health care. This perspective provides another way to squeeze costs from the system and /or redirect resources from tertiary emergency care towards public population health initiatives that prevent illness and promote good health to protect the population. So, as a society if we place our resources further upstream and invest in things like a safe healthy environment, a safe physical environment (housing transportation) and reduce homelessness and expand educational access, we may very well end up having to spend a lot less on health care later. Finally, does PBS have an “axe to grind” here. Of course, they do! That is the purpose of a documentary. The film maker/producer has a viewpoint and /or message and they want to persuade us in some way to see their side of things. So why was this film successful or unsuccessful in your opinion? What devices did it use to try and persuade you that something is wrong with our health care system and how we should go about changing it? |
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I appreciate your 2 cents! All very good points! There is a lot of waste in the healthcare system and we are seeing health systems looking at Lean strategies to eliminate the waste. We have new administration in the health system that I have been part of for my 26 year career. The Lean model is so intriguing to me and it absolutely can have benefit within healthcare. I often feel there are way too many administrators and not enough worker bees. My role is part administrator but I am focused on clinical operations and how to make things more efficient and patient care focused. It is quite difficult to sit in a meeting with an administrator who tells me how to run my independent clinics when he/she has not seen patients in over 15 years. So much has changed in healthcare with the electronic medical record, the Cures Act, value-based care, and need I go on? It is crucial that administrators who want to affect change within their systems to be “boots on the ground”. Be engaged, see patients, to experience what your teams are experiencing. Without fully understanding how things are going in the “weeds”, creating change will be difficult. Side note, I highly recommend Craig Albanese MD’s book on Lean in Healthcare. it is a few years old, around 2016, but a good read on the waste within healthcare and methods to reduce it. He recently came to Duke and is quickly implementing his life’s work there. It has been great to watch it evolve.