Rethinking government’s role in healthcare
There’s a lot of debate about government’s role in healthcare. Much of our attention is focused on fixing sickness not preventing disease.
We obsess about availability of doctors, hospital beds, staff and infrastructure to treat sick people. We don’t debate enough about government’s role in maintaining health of its population.
In America, the Centers of Disease Control (CDC), which focuses on prevention of diseases, has a budget of $10+ billion. Compare that to the budget of Centers for Medicare and Medicaid (CMS), which oversees federal insurances: $763+ billion.
76x more budget for fixing diseases than preventing them.
There’s an old Cherokee anecdote. A grandfather explains to his grandson about two wolves inside all of us. One good. One bad.
The wolf that wins is the one that you feed.
Between sickness and prevention, which wolf do you think is winning?
The baseline required to maintain good health is actually minimal:
1) Access to clean air and water
2) Access to uncontaminated food
3) Economic security to buy/grow food
4) Sanitary protection from germs
Over the last 75 years since World War 2, the developed world has greatly improved health of its population by addressing these baseline conditions.
The developing world continues to struggle. Success is sporadic.
Despite its progress, the U.S. is sicker than 11 high-income countries according to a recent survey by Commonwealth Fund.
The study found that one-third of U.S. adults went without care even with access to the world’s best specialists. They also chose to not take drugs they were prescribed.
They simply couldn’t afford it. Much like poor patients in developing countries.
Why isn’t access to healthcare resulting in better health beyond a point?
After a country meets baseline factors, the notion of what constitutes a disease-influencing environment changes.
There’s clean air. Safe water. Food in plenty. Not many deadly bugs biting around.
What we now contend with are different problems.
Problem 1: A new environmental Frankenstein
Excess food results in overweight bodies. Excess convenience results in sedentary lifestyles, which result in chronic diseases. Excess cleanliness results in weaker immune systems. Constant air-conditioning results in breathing problems.
With development, we move from killer germs to other killers. Killer food full of sugar and salt. To excessive dependence on prescription drugs. To caffeinated colas. To fast food. To modified milk and eggs. To a different kind of stress.
Read: 4 disturbing trends in healthcare (Refer #4 – Our environment is changing the rate at which we get disease)
What constitutes a disease-causing environment changes from country to country. For some it may be germs. For some others it may be sugar.
We have no policies protecting us from this new Frankenstein.
Problem 2: Unaligned financial incentives
Our world doesn’t fully recognize or agree on the problems we’ve created for ourselves in the last 50 years. Therefore, our health systems largely focus on fixing sickness. We don’t focus on protection from our environment’s new killers.
Our old way of thinking finds itself into the entire behavior of health systems. From innovations we value (e.g. drug-eluting stents) to how we train doctors (fixing and curing, not preventative) to how the system gets paid to function.
More complex a fix, the higher the pay. Naturally.
Angioplasty = more money. Consultation to avoid angioplasty = much less money.
We get what we pay for.
With the present payment structure, it’s in the interest of the industry that people get sick often (more customers), with more complications (higher paying customers), and stay sick forever (longterm customers). May be, I’m exaggerating but not so much.
Rethinking government’s role in healthcare
At the crux of healthcare reform is access and affordability. Undoubtedly important. But it’s not solving the entire problem. People with access to affordable healthcare continue to be sick. Why?
May be it’s time to take a few steps upstream in healthcare. Traverse the way up to the source of our problems and take action from that viewpoint.
Read this insightful TED book by Rishi Manchanda for more on the topic: The Upstream Doctors: Medical Innovators Track Sickness to Its Source
Imagine fighting over issues such as sugar-control or patient incentives for health maintenance or even systems that help people die in the comfort of their homes.
You get the idea.
For some countries, a higher-level issue may pertain to sanitation programs (to fix malaria). For some others, that may be controlling access to fast food (to fix heart disease).
Working on policy that goes to the source of problems (and not just fixes) will provide newer insights for reform.