By KIM BELLARD
My pals, we’re like explorers of yore standing on the fringe of a identified continent, looking on the huge ocean in hopes of discovering new, unspoiled, higher lands throughout it. True, we might have despoiled the continent behind us, however definitely issues can be higher within the new lands.
Within the metaphor I’m pondering of, the identified continent is our shambles of a healthcare system. For all of the protestations concerning the U.S. having the very best well being care on the earth, that’s manifestly unfaithful. We don’t dwell as lengthy, we now have extra persistent ailments, we kill one another and ourselves at alarming charges, we pay far more, we now have too many individuals that may’t afford care and/or can’t get hold of care, we now have an excessive amount of care that’s ineffective, inappropriate, and even dangerous, and we spend a lot an excessive amount of on administration.
We don’t trust the healthcare system, we don’t think its high quality of care is sweet, we now have an unfavorable opinion of it, we expect it fails us. The overwhelming majority of us assume it needs to be fundamentally changed or completely rebuilt. That’s what we wish to flee, and it’s no marvel why.
Throughout that metaphorical ocean, within the distance, over the horizon, lies the 22nd century healthcare system. It should, we hope, be like magic. It is going to be extra equitable, more practical, extra environment friendly, extra proactive, much less invasive, extra reasonably priced. We don’t know precisely what it can appear to be or the way it will work, however we’ve seen what we now have, and we all know it may be higher – a lot better. We simply must get there.
This leads me to the subsequent a part of the metaphor. I lately learn an excellent quote from the late nature author Barry Lopez, from his posthumous e-book of essays Embrace Fearlessly the Burning World. Mr. Lopez laments: “We’re looking for the boats we by no means constructed.”
The boats aren’t coming to save lots of us, to move us to that idealized 22nd century healthcare system. As a result of we by no means constructed them. As a result of we nonetheless don’t have the braveness to construct them.
We’ve by no means constructed a system to make sure common protection. We depend on a hodgepodge of protection mechanisms, every of which is battling its personal issues and nonetheless leaving some 25 million folks with out insurance coverage – and that’s earlier than the 10-20 million who’re predicted to lose protection as a result of “Large, Lovely Invoice” – plus the tens of thousands and thousands who’re “underinsured.
We’ve by no means constructed a system that was remotely equitable, simply as we by no means did for housing, schooling, or employment. Cash issues, ethnicity issues, geography issues. Discrepancies in availability of care and in outcomes present up clearly for every of these, and extra.
We’ve by no means constructed a system that prizes sufferers above all. We deferred to docs and hospitals, not calling them out once they gave us substandard care or once they charged us an excessive amount of. Now well being care has gone from a “noble calling” to a jobs and wealth creator. A recent New York Times analysis discovered (amongst different issues):
- Well being care is the nation’s largest employer;
- In 1990, well being care wasn’t the most important employer in any state; now it’s in 38 states;
- We spend extra on well being care than on groceries or housing.
Choose your favourite goal: private equity firms shopping for up well being care entities, for-profit corporations extracting income from our care (or nominal “non-profits” doing the identical), the regular corporatization of health care. Throw in favourite boogeymen like well being insurers, PBMs, or Large Pharma. A technique or one other, it’s concerning the cash, not us.
The adage about Large Tech involves thoughts: we’re not the shopper, we’re the product (or, as I’ve written before, we’re merely the NPCs.).
We’ve by no means constructed the methods to make administration simpler. So many codes, so many guidelines, so many kinds of insurance coverage, so many silos, so many directors. By now you’ve little doubt seen the chart of the expansion of directors versus clinicians in our well being care system, and are conscious that round 1 / 4 of our healthcare greenback goes to administration. It doesn’t need to be this manner, it shouldn’t be this manner, however administrative bloat is getting worse, not higher.
We’ve by no means constructed the methods to correctly observe our well being or dangers to it.
From wastewater monitoring to monitoring of ailments/outbreaks to adversarial impacts from prescriptions medication, medical gadgets, we’re counting on haphazard strategies that depart us with no efficient warning methods. The varied public well being mechanisms we had in place have been woefully unfunded previous to COVID, crashed (and have been burned) throughout COVID, and now are gleefully being defunded.
Worst of all, we’ve by no means constructed a system to trace what care truly works. Certain, there are gold customary managed research which might be supposed to do this, however a lot care that’s delivered shouldn’t be primarily based on such research, the impacts of such research take years to permeate precise apply patterns, and practitioners aren’t actually monitored to make sure they’re delivering the “proper” care or within the “proper” means. We undergo care, we pay for that care, with out actually realizing if it’s the care we needs to be getting or from the individual/establishment who needs to be giving it to us.
Disgrace on us, and the system that enables all this.
With out constructing all these boats, we’re not attending to the 22nd century healthcare system that we wish, and deserve.
Certain, there’s numerous thrilling know-how that can assist make issues look extra like a 22nd century healthcare system. AI, robots, genetic modifying, nanobots, sensible cells, artificial biology, and extra – these are all thrilling, and can all be helpful in that 22nd century healthcare. However they received’t get us to the 22nd century healthcare system we should always get. They’ll simply take us to a slicker, dearer model of the one we now have.
You will have seen {that a} couple weeks in the past was the 50th anniversary of the initial release of Jaws. Considered one of its most iconic strains was the Chief Brody’s response when he first glimpsed the scale of the shark he and two companions have been foolishly looking: “You’re gonna want an even bigger boat.”
In relation to getting us to the 22nd century healthcare system we should always need, we’re gonna want an even bigger boat too – and we higher begin constructing it now.
Kim is a former emarketing exec at a serious Blues plan, editor of the late & lamented Tincture.io, and now common THCB contributor
