Black Jet Theory – Volume 2020-6 – Is the Health Care System Broken? Can the Health Care System be Fixed?
June 5, 2020 by Marshall Snipes
Our world has changed. A recent survey reveals that, since March 13, 2020, “48% of Americans are in households where someone has had a loss of employment, 25% of Americans missed last month’s rent/mortgage payment or have little/no confidence they can pay next month on time, 41% have delayed receiving medical care because of COVID19 in the last 4 weeks, and 34% report symptoms of anxiety, depression, or both in the past week.”[i]. The Black Jet Theory[ii] (common sense and critical thinking) dictates that any changes to the healthcare system, either financing or delivering care, have to be made in the larger context of the economic crisis the pandemic has caused. Accordingly, can the healthcare system in the United States be fixed? In theory, the answer is a resounding yes. In reality, the answer is a resounding maybe but not likely.
The discussion starts with definitions and perspective. Healthcare historically has been the process of taking care of people who get sick or are injured with some attention more recently, to prevention of illness and injury. Health status on the other hand is the result or outcome of a combination of personal choices, social determinants, genetic endowments and the healthcare we receive. Most healthcare systems have some form of “improving the health of the communities they serve” language in their mission. If we as a society were to focus on improving health status, and the health care system was organized to do just that, then the health status of our citizens would improve, and the mission would be accomplished. The result would lower revenues for those who benefit from the current system. The healthier a person is, the less healthcare resources they would consume. This affects a lot of sacred cows who will not lie down easily. How could we then organize the healthcare system to accomplish the goal of improving health?
DEFINE STRATEGIES. If we can agree that the goal is improved health for everyone, then we have to define what the strategies are to fix the problems that are keeping us from achieving that goal. The health care industry in part has defined strategies. For example, the “Triple Aim” framework was developed by the Institute for Healthcare Improvement (“IHI”) to define those strategies for hospital systems. It is IHI’s belief that new designs must be developed to simultaneously pursue three dimensions, which are called the Triple Aim: (1) improving the patient experience of care (including quality and satisfaction), (2) improving the health of populations, and (3) reducing the per capita cost of health care.[iii]
Others see the goal and the strategies, differently. Many believe in a utopian society where the government would provide universal healthcare services for every medical need including “potential” needs. Potential disease would be treated thru vaccines and other drugs that sometime seem to be a solution searching for a problem. Accordingly, there would be a pill or a procedure for anything that might go wrong regardless of personal behavior, social determinants or healthcare you might receive. Unfortunately, it would require a dystopian society to accomplish that task, something akin to the Soma drug society of Huxley’s Brave New World.[iv]
But the strategies that exist today have not been successful in significantly improving access to care, health literacy or personal responsibility. Nor do they include the impact on health by addressing social determinants. All are factors that impact health status. All of these factors have been vigorously debated in the public square, but solutions have been slow to be formulated and executed. As a result, costs continue to rise with no apparent impact on public health or on the health status of our citizens.
STAKEHOLDER AGREEMENT. We have to have agreement among the stakeholders to participate in the fix, a seemingly impossible task. Health insurance companies, pharmaceutical companies, and medical equipment manufacturers are making enormous profits and have no incentive to change. In the Fortune 500 list for 2020, there are 40 health care companies representing 17% of the revenues of the Fortune 500 companies.[v] Those healthcare companies would likely not be in favor of any change that would lower their revenues. It’s easy to see why the opposition would be strong. According to the Center for Responsive Politics, in 2019, the healthcare sector spent $594 million dollars on federal lobbying or 17% of the total amount spent by all industries.[vi] According to Neilson, Pharma members alone spent $6.46 billion in advertising in 2019.[vii] That’s a lot of clout to combat any change to the status quo.
PUBLIC OPINION SUPPORT. The strategies have to be supported by public opinion. According to a 2018 Gallup poll, “Americans are largely unsatisfied with coverage for the country (66%), but they are satisfied (69%) with coverage for themselves”.[viii] According to the Kaiser Health Tracking Survey, “Support for Medicare-For-All has been consistent over the last few years at 59% for and 38% against”.[ix] However, “When Americans learn about increased taxes & the elimination of employer provided coverage” to pay for Medicare-For-All, the numbers reverse “36% for and 55% against.”[x]
The current pandemic has shifted the opinion of the public in the role of government in health care. “Nearly 70% of Americans believe the government should be doing more, a stark reversal from attitudes over the last decade about government’s role.”[xi] And, most Americans (59%) believe the healthcare system needs major changes or a complete redesign.”[xii] If you are confused, you are not alone, so is everyone else. It’s a difficult conversation and one that is unlikely to reach consensus.
Can the healthcare system be fixed? The answer is yes, IF we can agree on a national healthcare strategy, IF we can overcome the enormous push back from those who benefit from the status quo by obtaining stakeholder agreement, and IF public opinion supports the idea that the financing and delivery of health care need to change. Then the health care system can be fixed to align those strategies with public policy in order to achieve the goal of improving the health of our citizens. Common sense says all of those IF’s are not likely to happen anytime soon.
Don’t take my word for it. Think for yourself.
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[i] Lewis J. Interview with Jarrett Lewis, Partner Public Opinion Strategies. U.S. Census Bureau. National Survey conducted May 14-19, 2020. https://www.census.gov/data/tables/2020/demo/hhp/hhp3.html.
[ii] Snipes M. The Black Jet Theory is “the notion that most of what currently happens, when viewed through the filter of common sense and critical thinking, leads to a different conclusion, than the widespread view of current thinking by those who control the dissemination and content of information (academia, the media, politicians and other “experts”). Black Jet Theory – Volume 2020-1, May 1, 2020. Article upon request [email protected].
[iii] Institute for Health Improvement. Our goal: Triple Aim for Populations. www.ihi.org/Topics/TripleAim. Accessed June 5, 2020.
[iv] Huxley A. Brave New World. Harper & Brothers, Publishers; 1932.
[v] Ellison A. Fortune 500: 40 healthcare companies make 2020 list (published online May 18, 2020). https://www.beckershospitalreview.com/finance/fortune-500-40-healthcare-companies-make-2020-list.html
[vi] Evers-Hillstrom K. Lobbying spending in 2019 nears all-time high as health sector smashes records. January 2020.
https://www.opensecrets.org/news/2020/01/lobbying-spending-in-2019-near-all-time-high/
[vii] Kanski A. Nielsen: Pfizer tops list of biggest pharma advertisers in 2018. https://www.mmm-online.com/home/channel/nielsen-pfizer-tops-list-of-biggest-pharma-advertisers-in-2018/
[viii] Lewis J. Interview with Jarrett Lewis, Partner Public Opinion Strategies. 2020 and 2018 Gallup Poll. https://news.gallup.com/poll/4708/healthcare-system.aspx.
[ix] Lewis J. Interview with Jarrett Lewis, Partner Public Opinion Strategies. Kaiser Family Foundation. Kaiser Health Tracking Surveys. https://www.kff.org/health-costs/poll-finding/kff-health-tracking-poll-april-2019/.
[x] Lewis J. Interview with Jarrett Lewis, Partner Public Opinion Strategies. Kaiser Family Foundation. Survey January 9-14, 2019. https://www.kff.org/health-reform/poll-finding/kff-health-tracking-poll-january-2019/.
[xi] Lewis J. Interview with Jarrett Lewis, Partner Public Opinion Strategies. Gallup; Hart Research Associates. National Survey May 1-4, 2020. https://news.gallup.com/poll/268295/support-government-inches-not-socialism.aspx. And https://caringacross.org/wp-content/uploads/2020/05/FI12876-CAGNDWA-Topline-Results-for-Public-Release-May-1-4-2020.pdf.
[xii] Lewis J. Interview with Jarrett Lewis, Partner Public Opinion Strategies. USA Today/Ipsos. National Survey May 22-26, 2020. https://www.ipsos.com/sites/default/files/ct/news/documents/2020-05/topline-pa-usatoday-covid-2020-05-29.pdf.