Why Healthcare Seems So Hard to Fix

Here in the U.S. the debates and emotionally-charged discourse about the state of our healthcare system continue with no end in sight. The one thing most people seem to agree on is that our system is costly, inefficient, and ineffective. We seem to pay more than anyone else in the world, and, to hear so many people tell it, we're getting worse care than most advanced countries even though they spend less.

 But before we consider the different schemes for fixing these apparently horrendous shortcomings, let's get a little perspective here. As someone who has been involved in healthcare in many countries around the world for two decades, let me assure you that the one thing that's a constant everywhere is that people complain about their healthcare systems. Where healthcare is cheap or even free, people tend to complain much more than we do here in the U.S. about wait times, quality of care, and access to more advanced forms of care. Where advanced care is available, out-of-pocket costs for treatment are often much higher than they are here.

 And here's another constant to healthcare: When any change is introduced to a mature healthcare system, even one that's widely applauded, there's always a new round of complaints from people who insist the system has been made worse. Here in the U.S., we hear narratives about our excessive costs tracing to greedy, overcharging doctors, hospitals, insurers and pharmaceutical companies. I think that view is highly distorted, but it hardly matters, because there are equally enthusiastic (and likely equally distorted) narratives about the dangers of handing healthcare over to highly inefficient government bureaucracies.

 The truth is there will always be those who do better in one system than they would have under another system, and those who do worse, depending on their health, their affluence, their employment, their age, their healthcare preferences, and more. So when we try to fix a supposedly troubled healthcare system, some people will get better care or save money, while others may lose some level of access to some types of care or end up having to pay more for it. We can shift costs in many different ways--from insurance premiums to deductibles or vice-versa, for example, or from employers to taxes or vice-versa. But that won't reduce system costs, which ultimately we all pay for. And it won't improve quality. We can become smarter shoppers who gain access to more transparent pricing, which would likely produce savings for many. But anyone who does a lot of flying these days knows what intense price competition can do to service quality. Besides, we won't become smart shoppers unless we take on more out-of-pocket costs to motivate us. I think it would be a good idea if we did, but most of us simply don't want to do that.

 There are, in fact, ways we can change our system that will cut our costs and make us healthier at the same time. These win-win approaches all involve finding ways not to shift costs or narrow access to care, but rather to help us need less complex care by keeping us healthier in the first place. If our healthcare system supported us in adopting healthier lifestyles, more closely monitored us for early signs of disease risk, and made sure we received the early interventions that could nip these diseases in the bud, costs might well plummet, and we'd live longer with a higher quality of life.

 Note that those changes aren't directly tied to whether care is covered by employers or the government, to the size of premiums and deductibles, or to the rooting out and elimination of supposed overcharging. Sure, any and all of those factors could be tweaked to the benefit of some, maybe even most. But if we want a healthcare system that's less costly and that produces better outcomes for the vast majority of us, let's demand a system that takes good care of us before we need complex care. And even more important, let's focus on the HEALTH in healthcare and all do our share to adopt the healthy habits that will help keep us out of the hospital.