February 7, 2015

Let’s Get on with Solving our Health Crisis the Right Ways

Although the Obamacare legislation and the regulations issued by the Obama administration are misguided in major respects, including the structure of the health insurance system, the move to accountable care systems and the eventual payment of healthcare providers for delivering better health at lower cost is an extremely welcome development.  We must pay healthcare providers and every other stakeholder for making all Americans as healthy as possible and, even more importantly, providing the wellbeing that enables them to fulfill their human potential as individuals, families and communities.

Making this transition will not be easy for two reasons:

  • Too many people and firms make too much money in the current broken healthcare system.  We should be spending half as much as a society and getting far better results.  However, whenever someone says that there is a lot of fraud, waste, and abuse, which there is, I remember Peter Drucker’s comment that “One man’s waste is another man’s livelihood.”  Pharmaceutical companies, health insurers, medical device vendors, and hospital presidents make a lot of money.  The major losers in the existing healthcare system are primary care physicians, but they lack the organized political clout of these other stakeholders.
  • Changing work, life habits, destructive social relationships and other factors that contribute to bad health, even when everyone wants to change, is extremely difficult and will take a long time.

What needs to change?

  • Elected officials and regulators must behave consistently with the principle that bad health and poor use of the healthcare syste, does not primarily occur for reasons outside our control.  Health insurance should be designed to drive the right behaviors.
  • We have to stop acting as if the solution to better health is based primarily on healthcare system improvements.   Many different stakeholders make decisions that affect individual and population health,including federal and state fiscal policy makers, planning and zoning officials, food and beverage providers, employers, schools and colleges, community social service organizations, faith-based institutions, and the families and friends of every community resident.  All have to be involved in the solution, and, more importantly, they have to work in a coordinated and consistent fashion.
  • We are in clinical settings less than 1% of our lives.  For the rest of the time, we are the managers of our own health.  We need the best tools possible for continuous and effective health management.  It is common sense, but it is often forgotten: for most of human history, the view that we are the managers of our health, whereas physicians simply are support functions, is correct.  We need to stop depending on the healthcare system to clean up the messes we create in our lives.
  • Advocates for removing health insurance and healthcare management from employers are misguided and, usually, arrogantly stupid in their views.  When an advocate of “single payer” healthcare says that employers should have no role in producing healthy employees, that individual is clueless about the link between work-related conditions and employee health.  A work environment can make people healthier by giving them the energy from having a sense of purpose, the social support that gives them incalculably valuable resources, income and job security, and access to healthy foods, beverages, and physical activity during a good chunk of their waking hours.

The work environment can also be a source of stress that causes chronic diseases to take root, of repetitive trauma disorders like carpal tunnel syndrome, of musculo-skeletal conditions that result from too much sitting, lifting, bending, or standing, of violence, or of obesity from unhealthy foods and beverages.

Employers can make or break the health of an employed population.  They have to be part of the solution.

  • Robust and complete health data is a vital tool for everyone involved in managing individual and population health.  We have to stop allowing healthcare providers, insurance companies, pharmacies, and labs, and, more importantly, their software vendors like Epic, Cerner, Athena Health, and Centricity from obstructing the free flow of health data from one clinical system to another and from every clinical system to every patient.  There is so much nonsense and deliberate misinformation about how “HIPAA compliance” precludes data sharing.  The “P” in HIPAA stands for “portability”, not “privacy”, and it means that the patient, not the healthcare provider or the insurance company, owns the data and should have real-time access to it.
  • Employers need to understand that producing a healthy population requires high level leadership commitment, integrated effort among all staff and line functions, and recognition that reducing healthcare costs is a more certain way to produce shareholder value than starting and growing another large business.   Too many employers delegate health management to mid-level benefits departments and, relative to workplace-related injuries, mid-level risk management employees.  These individuals, in turn, outsource responsibility to brokers, consultants, and insurance administrators, none of whom can alter the internal conditions that give rise to healthcare costs from illnesses, diseases, or injuries.
  • Managing our health is continuous process, not something we do when we do not feel well.   Every decision we make every day affects our health, for good or ill.  We need to establish routines or habits that make it as easy as possible for us to do what works best for our health, whether it is what we eat for breakfast, how much discretionary physical activity we initiate every day, or how quickly and effectively we addresses the sources of stress in our lives.  Parents need to build healthy habits into the lives of their children early on, and to help them deal with the complex challenges they will face as teenagers when confronted with situations in which peer encourage them to engage in destructive behaviors.
  • Population health strategy must start with the President, who must lead an integrated effort across all executive departments.  Whether we have healthy Americans is not a responsibility of the Department of Health and Human Services.  It depends on transportation policy, educational initiatives, the way in which labor regulations are designed and implemented, environmental policies, and the way we address commerce and tax policies.  I would not suggest that we replicate the horrifically complex way in which the National Environmental Policy Act evolved, with litigations that tied up worthy projects for years or even decades. However, the notion that everything government does, allows, or rewards should contribute to a healthier society, or, at a minimum, should not make us less healthy is one whose time has come.

We are inching in the right direction in many respects.  Over the last four decades, we have demonstrated the ability to tackle big, seemingly unsolvable health-related problems:

  • We have cut the percentage of adult tobacco users by more than half.
  • We have significantly reduced the incidence of automobile-related fatalities.
  • The incidence of murders and violent assaults has significantly declined.

We can solve our health crisis!

However, the federal government is engaged in too much self-destructive conflict and gridlock.  As Americans, we deserve better!