Can We Clean the Swamp of Healthcare?

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Can We Clean the Swamp of Healthcare?

Health is an individual right and healthcare is a mission to a healthy life. As it is an individual right, we have the responsibility to develop a quality road map for this mission.

But the modern healthcare is a swamp! It is filled with political filth and legislative murk draining huge 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 which underutilize available medical technology. We are holding healthcare hostage to entitlement programs and continuously rationalizing corporate empowerment instead of empowering the 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 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 serious breaches of data privacy 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 he cost of healthcare is someone else’s responsibility. Many factors contributed in shaping up such a belief which mainly includes government entitlement programs like Medicare for the elderly, Medicaid for the poor and tax exclusions for employee health insurances.

The 2017 Milliman Health Cost Index revealed that the average American family availing employee health benefits contribute $7,151 in 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 difficult 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 and that means reforming the whole healthcare scenario.

We need to empower and engage patients to raise their awareness with information and support from healthcare teams. They should be actively engaged in the formation of evaluation methods for service providers that actually 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 a control over their own money. There could be no bureaucratically dictated value determined by entities which collect huge advance premiums from patients without delivering any actual care.

We need to come up with voluntary payment models that reward greater participation to achieve 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; at the same time, we have to preserve consumer rights and provide protection against fraud.

The system needs develop and expand payment models that form collaboration 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.

Physicians and care providers need timely access to accurate and up-to-date data like complete claims information t facilitate better care. The socioeconomic status of a patient may create a problem in providing care. The system needs to recognize this and adjust their 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 evidence-based test of alternate payment models. Only then the healthcare providers can learn how it works and evolve in clinical settings.

We need to bridge the gap between private and public sectors too.

Do we need Regulation?

If we choose to regulate the market, then 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 options which are controlled by third-party profit seekers.

Does it mean we can look but can’t touch? Or maybe touch but not taste? Maybe taste but not swallow?

If we 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 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 in the future. The idea of single payer vehemently contradicts many aspects of personalized 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. We are blinded by the solutions 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!

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“Peace of mind would come to all people through the universal respect for the basic human rights of everyone”

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