Things May Be Looking Up for Healthcare

I like to distinguish between "health care" and "medical care". Health care is often a personal behavior matter and from that standpoint much of it is free. Following a sensible diet, staying physically active, getting adequate rest, good hygiene, avoiding tobacco, excessive alcohol and other intoxicants cost nothing and these practices go a long way toward maintaining health and extending life. Medical care, on the other hand, is not free. Doctors, nurses, hospitals, drugs and medical tests and devices must be paid for. How is it that we've been led to buy into the concept that when it comes to getting medical care we needn't bother our heads about the cost. Someone else will pay the bill.

It isn't true! It's us who pay the bill. Who else is there really? And the system we use for payment makes the costs go way up so we pay way more than we should and besides that it restricts our choices, reduces the quality of services and stifles innovation.

Here are some interesting facts. A study done in 2013 revealed that in that year government (that is, U.S. taxpayers) funded 64.3% of medical care expenses and rising. In Canada by comparison the figure was 71%. In 2015 medical expenses took up 17.5% of GDP and this is forecasted to rise to 20% by 2025. That's a fifth of what we earn going just to medical payments. Medical costs continue to rise faster than the GDP. Medicare is 20% of the overall costs and is rising the fastest, even though Medicare controls the prices of every medical service and product that it funds.

Obamacare tried to address the disparities in our system by mandating that everyone have medical insurance and mandating what it must cover. This approach did not lower prices, it increased them. Prices for medical goods and services in our third party payment system are way higher than they would be in a market based system. Moreover usually neither patients nor providers know the prices. This situation is threatening to everybody's financial welfare but is especially problematical for those who are out of the system and must pay the grossly inflated prices out of pocket.

All of these data and economic concepts are well known to medical economic experts but have been discounted by healthcare planners in the Obama administration who have favored increasing government control for solutions.

In my 50 years in medicine I had never seen the morale among my colleagues lower nor the future for medical care looking bleaker. The changes since the recent election have brought me a sense of cautious optimism. Trump has appointed Dr. Tom Price, physician and U.S. Representative from Georgia, as head of HHS (Department of Health and Human Services) and Seema Verma, a medical economic expert formerly serving under Indiana Governor Pence, who will run CMS (Center for Medicare and Medicaid Services). Both of these individuals fully understand the principles described above and are determined to carry out changes accordingly. This will be no easy task and must be done carefully so as not to cause disruption to those who have been accommodated to our present system despite its serious flaws.