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April 4, 2016

Radical Approach on Healthcare Crisis

Summary:

"Mandate" is a difficult word, but we may have to require that people be healthy, to get beyond our healthcare spending crisis.

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I love health policy, healthcare technology and using “corkscrew” thinking to find solutions for big problems. Perhaps no problem looms larger today than our current healthcare crisis and its financial implications for our future.  

The U.S. healthcare system needs more than a healthy shot in the arm—it needs a cure. Premiums continue their upward surge. More Americans are going into debt because of healthcare. Fewer workers are funding a growing Medicare base. There is a heavy shift of enrollees to Medicaid coverage, drug prices keep climbing and people are living longer.

In the last decade, top healthcare analysts, industry leaders, medical school experts, bloggers, public policy wonks, foundations, think tanks and politicians have had plenty to say, but the American consumer continues to be hit hard.

Current (and evolving) solutions we have to fix healthcare include: the Triple Aim, affordable care organizations (ACOs), private- and public-sponsored medical research, disease fundraising, population health management, electronic health records (EHRs), high-tech abuse/fraud solutions, new drugs, end-of-life talks, Obamacare and the future of pay-per-value.

See Also: Why Employers Should Comply With Obamacare Mandate

Everything about our healthcare crisis screams for utilization that is more selective, has a greater efficiency and can lower costs. But the red light on healthcare’s dashboard says there is a bigger issue. It’s something that, when fixed, will provide a greater benefit for generations to come.

That red light alerts us to the fact that, out of the $3 trillion spent per year on healthcare, 86% is related to chronic disease—many of which can be prevented, delayed in their onset or better managed earlier. Per the Centers for Disease Control and Prevention (CDC), the costs and figures are simply staggering. If the world’s largest company was going under, its underlying financials couldn’t look any more crippled.

Everyone has been looking at our national healthcare crisis in the wrong way. The solution is not to provide everyone with health coverage but to take strong, legal steps to teach, coerce and even mandate that the majority of American children and adults become healthy, through individual accountability.

“Mandate” hits a nerve, especially to those like myself who value the strength of our individual freedoms. But, historically, a large number of American citizens have consistently shown they do not value their health. When value is lost, the effect is often poor choices and subsequent long-term management. This leads to the development of sustained drivers, culminating in the onset of chronic disease(s), the major cost driver of our healthcare crisis.

For starters, nearly 50% of all American adults (117 million) have a chronic disease, and 25% have at least two. More than a third of our country (35%) is obese. Nearly half of U.S. adults (47%) at least have uncontrolled high blood pressure or uncontrolled high LDL cholesterol or are smokers.

“Steve, that is the individual’s choice, and that person has to live with the results,” you say. Sure, personal responsibility is key. However, for the healthcare markets, one person’s chronic disease affects everyone in the system.

Subsidies and public coverage, such as Medicare and Medicaid, run off taxpayer money. Private insurance prices group and individual premiums from risk pools. Therefore, there is no misunderstanding—today’s unhealthy people cost healthy people money both now and in future generations.

Almost everyone agrees that eating a carrot is better than eating a donut, that running two miles a day beats chain-smoking a pack of cigarettes. If that’s the case, why aren’t people making the needed changes?

Simple : Those people do not value their health. Therefore, they do not take actions to improve or maintain it.

Having individuals value their health on a mass scale is the answer to lowering chronic disease rates. Lower disease rates lower cost for care, resulting in more affordable healthcare for everyone.

ACOs, EHRs, increasing pay-per-value reimbursement helps lower costs and creates efficiency but does very little to drive individuals to value their health.

When someone makes a decision on just about anything, there are only two reasons: to gain pleasure or to avoid stress or pain. You might eat a chocolate bar, craving the sweet taste. Or you might quit smoking, after the first heart attack, where the strong possibility of death has set in.

Here’s the thing. For most people 25 and under, if they already “feel good” physically, neither trigger is in play. By the time they “feel bad,” many chronic diseases may already have had an irreversible foothold for years or decades. Early detection for everyone is tremendously important and desperately needed.

Many young Americans don’t go to the doctor, because they “feel good.” The initial motivator to get people to value their health is not public education, throwing large data points at them, getting them on high-deductible healthcare plans or using fear marketing. Rather, we must create an instance where people will get massive amounts of pain from not going to get a checkup or screening. The law must require every insured and uninsured American to have routine physicals and screenings.

Basic Outline of Program:

  • There must be repetitive and selective screenings, depending on gender and age.
  • Those who do not get screened receive a financial penalty, paid directly by individuals from their taxes or through their paycheck, or deducted from their social program or subsidy benefits.
  • Subsidies would cover the patient portion for screening, whether insured or not.
  • Results would be tracked, individuals would be counseled and any further results on subsequent actions would be tracked.

Yes, this plan will drive up costs on the front end. Look, it took us a lot of time to get to this healthcare crisis, and it will take time to undo it. If we believe we can find a short-term solution to reverse this, we are kidding ourselves.

See Also: Endangered Individual Health Market

The most important result is gaining proper management for the long term, allowing affordability for future generations

There will be those who claim individual rights will be lost when such coercion takes place (just think about how the Affordable Care Act was positioned as a tax). In the end, if we didn’t have such nasty, costly surprises on the middle and back-end portions of our lives, we wouldn’t have to make these changes.

Perhaps if doctors, insurers, drug companies, hospitals and other medical services reduced their revenues, affordability would be in hand. But here’s a reality check: The U.S. healthcare sector is growing faster than any other sector in the country. Companies, employees and shareholders are not going to reduce their financial interests and current way of life for the average American consumer to afford care.

We need something new. We do not need something to work against businesses but something to work for people.  People can, then, with better personal health data, be motivated to gain more than ever in their current and future health.

Americans have always been strong enough to call upon resolve and forward thinking. Now, we live in the time of “what’s in it for me?” Sometimes, mandates are necessary to get people to see the importance of helping their fellow man, instead of themselves.

People are dying unnecessarily. This will continue if we don’t stand for more than ourselves. Let’s come together to give more people the chance to make better decisions and to live healthier lives.

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About the Author

Steve Ambrose is a strategy and business development maverick, with a 20-plus-year career across several healthcare and technology industries. A well-connected team leader and polymath, his interests are in healthcare IT, population health, patient engagement, artificial intelligence, predictive analytics, claims and chronic disease.

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