Can We Clean The Swamp of Healthcare?

Updated: Jul 18

Photo by Ihsan Aditya from Pexels
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 healthcare dollars. We are bombarded with a 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 and halfway planned strategies that underutilize available medical technology. We hold healthcare hostage to entitlement programs and continuously rationalize corporate empowerment instead of empowering physicians and patients.

Our evaluation system is biased with imbalanced reimbursements while medication 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 the personal privacy of patients 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 tend to believe that healthcare costs are someone else's responsibility. Many factors contributed to shaping such a belief, including 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 of employee health benefits contributes $7,151 in direct employee contributions while paying another $4,534 pot out 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 forming 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

For starters, we need to go back to the value-based payment where patients have control over their own money. There could be no bureaucratically dictated value determined by entities collecting huge advance premiums from patients without delivering 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. We should free waivers from fee-for-service legal and regulatory shackles that hamper collaboration and shared accountability; simultaneously, we must preserve consumer rights and protect against fraud.

The system must 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 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. Healthcare providers can only 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- one-sided action is destined to fail! It makes no sense to implement performance-based reimbursement if the parties don't access 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 must step out of the woods and drain the draining swamp! We must look at the big picture and reform point of care delivery, telehealth, and practice model for physicians.

We should also include interoperability and security in our priorities, and we need to connect both in a synchronized way. We will gradually transform to personalized healthcare through technology-oriented healthcare patients and needs.

Deregulation is