As I sit here contemplating the future of health care in America, my mind wanders back to the time I spent as a young doctor working in inner city hospitals taking care of the poor who were either uninsured or covered through Medicaid. I wish that more our Congressmen could have shared that experience witnessing first-hand what poverty and lack of health care do to people.
As we embark upon a contentious debate over changing the Affordable Care Act, lost in the rhetoric is that the central problem in US healthcare is that healthcare costs too much. If premiums were lower, more young healthy people would have purchased insurance, premium increases would be lower and more manageable, and wage growth and state budgets would not be consumed by healthcare cost growth.
It is well-known that healthcare in the United States is too expensive and rising too quickly. The single causal factor that gets the least attention is the amount of care that is delivered that is simply wrong or wasteful, commonly referred to as “inappropriate care.” According to some studies, inappropriate care wastes up to 30% of the total health care spend in the U.S.
Covered California was established as an independent state-based organization with a mission to expand coverage for Californians by creating a consumer-centered marketplace that was anchored in the “triple aim” of better care, lower costs and improved health.
Healthcare is a strange business. I recall a few years ago when one of our hospital presidents announced that we didn’t have a very good month financially, because we “didn’t have a good flu season.” What she meant was this: Not enough people in the community got sick so we could profit from treating them. As a doctor as well as a health system CEO, I was appalled. But from a financial standpoint, she was right: though our mission was to provide exceptional care to help our patients get well, we made money when they were sick.
Health care costs too much, and the chorus of disapproval laments the 17.8 percent of the nation's Gross Domestic Product spent on health care. So what would happen if healthcare providers were liberated from the reliance on payments that reward doing more, regardless of outcome? By declaring fee-for-service dead, we could enjoy the birth of a new era of health-focused care that is person-centered, efficient, and equitable, and results in outcomes that promote or restore health.