Health Care in America 101: Part 4- The Way Forward

The final article! US Health Care. How do we fix it?

Health Care in America 101 concludes with our final article on how we fix health care in the US. I have tried to give you an insiders look at what is wrong with US health care, who profits and how. Let’s look at solutions!

This is a final of a four part series looking at a pictorial guide to health care in the U.S. You can find the previous blogs here:

Health Care in America 101: Part 1- Why is it F#cked Up?

Health Care in America 101: Part 2- Who Pulls the Strings?

Health Care in America 101: Part 3- How Are We Ripped Off?

Health Care in America 101: Part 4- The Way Forward

I tried to make it a little fun, less words, more pictures. Click on any picture or graphic if you want more information.

In Part One we saw how much more expensive health care is in the US and how we don’t necessarily get what we pay for.

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In Part Two we looked at who the players are who drive up costs in the U.S., mainly drug companies, payers and large hospitals.

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In Part Three we looked at how payers, drug companies and hospital tactics to protect their bottom lines pushes up health care costs.

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In this final part, Part Four, we will look at potential solutions.

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Below are just talking points, not as many pictures or links as the other parts. Again, I’ve worked in 3 different health systems and saw the good and bad of each. Below is what I think would work and does work in other systems. The biggest complaint of systems like Canada is access. Systems with a public and private sector, like Australia, address access.

One thing that the Coronavirus pandemic has shown us, is that our health care system is a paper tiger. So many people have suffered and died. We have so much wealth, so many resources but they have not been well utilized.

We need to find a better way to do things. We need to put people before profits. Here are some steps to think about:

1.    Look at other health systems

Not Canada but Australia. Insurance for all but you can buy additional private health insurance not tied to your job and not bloated and expensive. A two tier system does not need to break the bank. The current focus on the pros and cons of a single payer system misses the point that the system as it is, is too expensive.

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2. Transparency

At every level. Hospital charges, insurer charges, physician charges, approvals, with no surprise bills. This is a big one. Mystery is a margin. Hospitals, PBMs and payers do not want this and don’t want us to see what they charge and what things cost. Hospitals fought this recently, and lost. We need it.

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3.    Emasculate big pharma.

Use market size to bargain down drug prices. Get rid of PBMs. Get away from orphan drug protection (see Part 3). Make sure when patents expire that drug companies cannot ‘evergreen‘ them. Make the generic market stronger. Look at how pharma is dealt with in other countries.

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Don’t let them raise prices of drugs indiscriminately:

Remember, the vaccine business for pharma will be a huge money maker:

4. The Government, like the VA system has to negotiate drug prices.

5.    Health care needs to be a free market.

“In a free market, goods and services are allocated through transactions based on mutual consent. No one is forced to buy from a particular supplier. No one is forced to engage in any transaction at all. In a free market, no transactions occur if a price cannot be agreed. The medical industry exists almost entirely to serve people who have been rendered incapable of representing their own interests in an adversarial transaction. When I need health services I often need them in a way that is quite different from my desire for a good quality television or a fine automobile. As I lie unconscious under a bus, I am in no position to shop for the best provider of ambulance services at the most reasonable price. All personal volition is lost. Whatever happens next, it will not be a market transaction.”

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6.    Pay nurses (and teachers) well.

Frontline workers provide the day-to-day care. Nowhere was this more apparent than the pandemic. “Thank you for your service” and recognizing health care workers with applause only goes so far. They need to be rewarded for the risks they take:

We can’t lose them. Stop exploiting them.

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7. Make private health insurance companies put their profits back into the system to reducing premiums.

There is a hypocrisy in premiums rising but profits for the payers also rising.

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This has never been more apparent in the recent pandemic where they are one of the few industries too profit from the country’s misery.

8.    Standardize pre-approvals and prior authorizations

The bureaucracy is dismantled. Offices will need less staff. This will reduce payer profits but they will need less administrative personnel

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9.    Reduce the number of hospital administrators.

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11.    Make Not-For-Profit hospitals more accountable for providing care to the community.

If health care for all is available, hospitals need to show transparent and open about reinvestment in the local communities in order to obtain tax credits. The gains should be balanced by forgiving bills on those who cannot afford them and charity.

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12. Put people who have actually looked after patients back in charge.

Compassion and empathy are lost by those who have never worked on the front line, worked a night shift in a hospital.

13. Limit and control vertical and horizontal integration

Stop monopolies on the supply chain and potential collusion

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14. As consumers, shop around.

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15. Avoid hospital facility fees if you can for procedures like MR scans.

Shop around for the cheapest rates.

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16. Cap medical bills and legislate against surprise bills.

Look at ways to avoid them in the interim:

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Change is coming:

17. Complain to State Insurance Commissions for unjust denials and charges

Here are the links for Nevada and California but you can find your state easily enough:

Nevada: http://doi.nv.gov/Consumers/File-A-Complaint/

California: http://www.insurance.ca.gov/01-consumers/101-help/

18. Don’t tie health insurance to your job

Lose your job, lose your insurance. This should not be how it works. We need to have the ability to buy health insurance coverage at a reasonable cost without needing our workplace to provide it as a benefit.

 

19. Keep asking questions

 

20. Vote with our feet in every way:

Where we get our pills, x-rays and services, which hospital we have our surgeries, which payer we align with. Who we elect in our next election.

All of the suggestions above that cut into corporate profits of payers, drug companies and hospitalsThese stakeholders have the best lobbyists and the deepest pockets and will fight change as they have the most to lose. It’s not about ‘single payer’. It’s about reducing the cost of health care in the U.S., making it transparent and a free market letting supply and demand dictate price. There lies the rub. Nothing will change wild the big three pharma, hospitals and payers keep using middle America as an ATM and we keep tolerating the bleeding.

The pandemic has shown much of America that we are wearing the emperor’s new clothes. We either have no insurance or we pay so much and are scared to use it.

If we get sick, the bills keep rolling. We should not see headlines like this in this great nation:

We need to get to word out. Things have to change.

Thank you for reading these four blogs. This is not meant to be politically biased one way or another. I am both a democrat and a republic and form my opinion based on the issue at hand. This is about doing what’s right.

n this blog and upcoming blogs we will cover the following:

Health Care in America 101: Part 1- Why is it F#cked Up?

Health Care in America 101: Part 2- Who Pulls the Strings?

Health Care in America 101: Part 3- How Are We Ripped Off?

Health Care in America 101: Part 4- The Way Forward

Agree? Disagree? Feel free to like or share. The pictures all link to the original source so please explore. Feel free to leave a comment below.

Author:

Lali Sekhon, MD, PhD, MBA| Father | Husband | Neurosurgeon| Hockey Fan | Innovator | Inventor | Educator | ΒΓΣ | Health Care Leader | I'm a neurosurgeon (MD, PhD, MBA, FRACS, FACS) who has been a physician for over 30 years. I'm also a tech junkie and a cynical optimist. Having completed a medical degree, a PhD and an MBA, I can give you an honest opinion on anything related to medicine and health care with tips and reviews and commentaries. Some of the topics are related, others, somewhat related, but all for the layperson: honest, simple and practical. It's not brain surgery!

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