Tuesday, October 18, 2011

Occupy Healthcare

Why do we need to occupy healthcare?  Why are we here, on this website, calling for change?  We are so often told that America has the best healthcare system in the world.  If that were so, then there would be no need to change anything.  We could continue running things as we currently are, and all would be well…

Except that we do not have the best healthcare system in the world.  And we do need to change our current dysfunctional system. 

When I make this statement, naysayers usually point out that America is the destination of choice for people all over the world who come here for care of their complicated medical problems.  Advanced cancer, for example—the US is apparently the place to be if you need high tech, high-intensity care.  Another argument is that patients come here to jump the line to get hip surgery or heart surgery that would require a much longer wait in their original country…although it is not often that this claim is supported with evidence that the procedure in question could not have waited.

So: I have staked a position, one that is contrary to the common wisdom.  I have made the claim that American healthcare is not the best in the world.  It is now necessary to defend this position:

•    American healthcare is not #1 in the world.  In this World Health Organization (WHO) analysis, the US ranks 37th.  We place just behind Costa Rica.  Other nations that outrank us: Dominica, Chile, Saudi Arabia, Cyprus, Greece, Colombia, and Morocco.  Just below us: Slovenia, Cuba, Brunei, New Zealand.  Essentially every developed nation in the Western Hemisphere performs better than we do.
•    It’s worse than it looks: as this analysis shows, we are 39th in infant mortality, 43rd for adult female mortality, and 42nd for adult male mortality and some of the US’s quality measures have not increased as much as other nations’.
•    We rank last among seven developed Western-style democracies in US healthcare performance (graphic here).  We ranked 7th out of seven in efficiency, equity and “long, healthy, productive lives” 6th in quality care, and tied for 6th in access.  This last category (access) is ironic, given that many of the arguments against reforming the US healthcare system focus on the potential loss of patients’ access to their physician; it appears this access is not as robust as we might believe.
•    Our healthcare spending per capita is 50% greater than the next highest nation’s, and our healthcare spending in the US is increasing faster than most other nations’, and the % of national GDP spent on healthcare in the US is the highest in the world (reference here).
•    According to this just-released report from the Commonwealth Fund, the US scored 64 out of 100 points and lagged behind other developed nations.  You can see the short version of the report here.

Americans pay much more per person, to support a health care system that does not function very well at all, that provides inadequate and unequal care for far too many people (pdf), and that leaves nearly 50 million Americans without health insurance. (pdf)  These are all indicators of a system with significant, fundamental dysfunction.

How can we tolerate this?  How long do we continue paying for a system that is not meeting our needs, and that is costing us more and more?  How long can we continue draining resources on a system that is unequal and that does not meet its intended goals?

Every system is perfectly designed to produce the results that it is producing.  If we continue doing the same things, we will continue getting the same results…only at ever-greater cost.  Even with the passage of the Patient Protection and Affordable Care Act (PPACA), the fundamental structure of our system will not change, and we will still need to find ways to make our healthcare system more effective, equitable and efficient.

We cannot continue the status quo.  We must occupy healthcare, and we must fight for reform that will make a true difference for our nation and improve our fellow citizens’ health.


nicholasC said...

I agree with your evidence-based claim about our health care system's dysfunction. I'm more curious about what reforms occupiers would be advocating for? What is the ideal solution to deal with patient costs, while also considering underpaid health care workers?

mark said...


Thanks for the comment. This post is intended to call attention to the problem. When time allows, I'll try and write about some answers.

A. Patrick Jonas, MD said...

Thanks for your timely evidence about our failure to care for our citizens. A fundamental change in the world of physicians is needed to bring our profession back from being co-dependent with the forces that bankrupt America and call it quality. The medical profession turned over healthcare to business people, thinking they would do well with management of the business issues in healthcare. They went way too far, though, in going with dollars and technology and away from the needs of people. Follow the dollars and find where we undermined the health of our nation's people.
The people deserve better.

Thomas Loker said...

"Clearly there is much to be done to fix the system we think we have for health care. First and foremost is to actually understand what we really do have and what it is we should actually expect from Health Care.

There is a huge difference between what we think we are getting from our health care system and what we actually receive.

There is even a very large gap between what we think we are paying for care and what we actually pay.

We also do not truly know what the drivers of cost are in this system nor the reason for the perpetual cost increases.

All of these are fundamental issues in our health care system or lack of system.

In writing me recent book I explored why our current system is so dysfunctional and how we have arrived at the system we currently have. Most importantly, I discuss why the perception we have over our current system is so far removed from the reality of what we truly have. What most don’t realize is that the system we have today is less of a system than an amalgamation of dis-integrated decisions that have been made over the past 200 years. It is the unintended consequences from these decisions that we still suffer from today.

The research was a very enlightening trek for me and I think it is imperative for all of us if we expect to solve the current problems.


Jessica Scott, MD, JD said...

Improving quality and efficiency in health care, as well as access, are national imperatives. We need to learn more about the errors, near misses and inefficiencies in health care in order to improve the system. Doctors and hospital staff will continue to be reluctant, however, to disclose and be transparent as long as the fear of a lawsuit looms near.

Yet, patients who are harmed deserve to know what happened to them, they deserve an apology if one is indicated, they may want to know that a recurrence will be prevented by improved processes, and they may even need some compensation.

We can make this happen in a safe supportive forum that will not only meet the needs of those involved but also meets the needs of society allowing us to improve health care and make it safer! We can do this without increasing the risk of litigation and with decreased overall expense. Resolution of conflict that meets the needs of those involved within months after an unexpected adverse outcome rather than years prevents years of anger and resentment and may allow for compensation when patients/families truly need it in order to meet needs relating to the harm they incurred.

Health care workers including doctors, nurses and other medical staff also suffer emotionally as "second victims" after medical errors occur. Many develop anxiety or depression, stress related illnesses; some leave their jobs and professions entirely. Society pays ultimately for the costs associated with higher staff turnover and greater rates of error due to stress and distraction.

An alternative to our tort system that resolves conflict early on using Collaborative Law for medical disclosures is powerful and will help doctors, patients and society by allowing us to learn where the errors and poor health care quality exist. The Institute of Medicine estimates that 90% of these errors can be prevented by better process and system design. By providing a safe and effective forum for resolution of conflict and transparency, improve quality of care and safety, and over time we may reduce the practice of defensive medicine thereby giving us health care dollars we can use more productive elsewhere in our health care system.