Health is an individual right, and healthcare is a mission to a healthy life. As it is a personal right, we must develop a quality road map for this mission.
A Swamp that Pulls Everyone In!
But modern healthcare is a swamp! It is filled with political filth and legislative murk draining vast amounts of healthcare dollars. We are bombarded with series of amendments and pass executive orders one after another while placing mandates on top of mandates- all end up as elusive magic proposals to solve healthcare problems.
We have thousands of pages dedicated to Affordable Care Act (ACA) provisions coupled with halfway planned strategies that underutilize available medical technology. We are holding healthcare hostage to entitlement programs and continuously rationalizing corporate empowerment instead of empowering physicians and patients.
Our evaluation system is biased with imbalanced reimbursements while medications costs are shooting for the sky. We have created a record of paying the highest insurance premiums in a monopoly market controlled by pharmaceutical and insurance company interests. The patient is losing his autonomy while independent physicians constantly receive the blame and are targeted unfairly.
News reports are coming out about severe data privacy breaches and personal privacy of patient and health information, exposing them to various risks.
The whole system has turned into a swamp — the healthcare swamp, and some feel it is too complex to be solved with a simple solution.
The Dark Side of the Swamp
Americans have developed a tendency to believe that the cost of healthcare is someone else’s responsibility. Many factors contributed to shaping up such a belief that mainly includes government entitlement programs like Medicare for the elderly, Medicaid for the poor, and tax exclusions for employee health insurance.
But the view is entirely against the harsh reality-
The 2017 Milliman Health Cost Index revealed that the average American family availing employee health benefits contribute $7,151 in the form of direct employee contributions while paying another $4,534 pot of their own pockets! Employers put in their share of $15,259 as part of their contribution.
It’s challenging to find the bottom of the healthcare swamp, which is pulling everyone in!
How to Drain out the Swamp
We cannot clean a swamp without draining it completely, which means reforming the whole healthcare scenario.
Empower the Patients
We need to empower and engage patients to raise their awareness with information and support from healthcare teams. They should be actively involved in the formation of evaluation methods for service providers that apply in their case. All public and private players should also report their performance consistently and transparently for greater accountability.
Return to Value-Based Payment
We need to go back to the value-based payment where patients have control over their own money, for starters. There could be no bureaucratically dictated value determined by entities that collect huge advance premiums from patients without delivering any actual care.
We need to develop voluntary payment models that reward greater participation for achieving the highest quality and value based on patient preferences and a competitive market. Waivers should be freed from their fee-for-service legal and regulatory shackles that hamper collaboration and shared accountability; simultaneously, we have to preserve consumer rights and provide protection against fraud.
The system needs to develop and expand payment models that collaborate between financial services and care providers. All stakeholders, including healthcare providers, providers of long-term care services, and clinicians, should be aligned using incentive-based payment.
Improve the Infrastructure
Physicians and care providers need timely access to accurate and up-to-date data like complete claims information t to facilitate better care. The socioeconomic status of a patient may create a problem in providing care. The system needs to recognize this and adjust its payments to providers appropriately.
Medical innovations and treatments that could potentially improve care quality and reduce cost should be incentivized. We need more private and public investment to develop and perform the evidence-based test of alternate payment models. Only then the healthcare providers can learn how it works and evolves in clinical settings.
We need to bridge the gap between the private and public sectors too.
Do we need Regulation?
If we choose to regulate the market, it shouldn’t be only for physicians and patients- because one-sided action is destined to fail! It makes no sense to implement performance-based reimbursement if the parties don’t have access to all third-party profit-seekers control options.
Does it mean we can look but can’t touch?
Or maybe feel but not taste?
Maybe taste but not swallow?
Let's walk the path of single-payer or Medicare for all or any national healthcare plan. The population-based “single-payer” healthcare model is the best, with total governmental control over every aspect of the healthcare delivery process. But do the majority of citizens want that?
I have been talking about personalized medicine in my articles which seems to be where healthcare is headed. The idea of single-payer vehemently contradicts many aspects of customized healthcare- are we looking to add more dump in the already murky swamp?
All the irrelevant solutions are ineffective in addressing the underlying problems of healthcare. The solutions blind us, but we need to step out of the woods and drain the begin draining the swamp! We have to look at the big picture and reform point of care delivery, telehealth, and practice model for physicians.
Interoperability and security should also be included in our priorities, and we need to connect both in a synchronized way. We will gradually transform to personalized healthcare through technology-oriented for healthcare patients and needs.
Deregulation is necessary when regulation proves ineffective. We should avoid one-sided solutions and expand our tunnel vision!
Let’s take a walk out of the woods, look at the big picture, and then assess the problem- otherwise, we are dealing with an elephant in a dark room!