One of the many great things about parenting is playing the same games with your children you yourself played as a child. Some things change, many others stay the same. The other day I was playing Would You Rather with my sons, ages 5 and 7. We were debating, “Would you rather eat only your favorite food for the rest of your life, or eat all foods but something you hate to eat once per week?” In this moment I made a deep connection to my professional life. I started playing Health Care Would You Rather in my mind.
For many years we’ve been having a national debate in the traditional health care industry (payers and providers) about how our health care delivery system is too expensive, too administratively burdensome and wasteful, hovering for the last few years at just above 17 percent of GDP, on a terrible trajectory to bankrupt us all. It’s a real burning platform. You’ve read all about it right? We spend much more than any other developed country per capita on health care, yet we have poorer outcomes; we are sicker and fatter, we are on more meds, we die sooner and we have more chronic conditions.
Lately the dialogue is evolving a bit. You read “the reason things are so bad is because we wait until people have one or more chronic illnesses or need emergent care before we intervene; and by then it’s too late,” “We don’t have a health care system, we have a sick care system,” “We spend too much money on the 20 percent who are the sickest of the sick and those at the very end of life.” Again, all true.
“Health Care Would You Rather” is a simple way to take another angle on this debate. When we pull costs out of the broken system we can use that money for other things, right?
I asked myself, exactly WHAT other things would we spend all that saved cash on? Shall we return money to investors and shareholders? Give our industry a raise? Perhaps more nobly, give it away in free care to the needy? Should we spend it on health IT to support efficiency, or precision medicine to look for new treatment pathways? Should we invest in behavioral health care and in ending the opioid epidemic?
There is another chart that doesn’t surface as much as that scary 17.5 percent of 2014 GDP number I keep hearing about. This chart (published in Elizabeth H. Bradley and Lauren A. Taylor’s 2013 book The American health care paradox: Why spending more is getting us less) compares a selection of developed countries and has arrived at another number, which is a range of 20-33 percent. Turns out, when you add up the sum total amounts paid into the traditional health care (“sick care”) systems plus the sum total of the social service investments you get this range. The chart shows that in 2013, the U.S. spent 13 percent of GDP on health care and 9 percent on social services (social services defined as housing assistance, employment programs, disability benefits, and food security - all the stuff upstream of “sick care”).
So challenge yourself to a game of Would You Rather:
Would you rather a) fund keeping kids fed healthy meals and active, helping them avoid diabetes, or b) pay for all the medical and lifestyle costs once people get Type II?
Would you rather a) provide broad, de-stigmatized access to behavioral health care in Anytown, USA or b) pay for inpatient visits, 30-day rehab and institutionalization?
Would you rather a) support healthy choices like yoga and exercise, good nutrition, health literacy and self-care, and interventions like physical therapy or b) pay for elective surgeries and recovery?
Of course our health care system is not that simple. I get that. But our health care system is broken, and that graph shows us that as a country, we are spending all that money either way, we are just prioritizing different things than the rest of the developed world. Are they right or wrong? Are they better than us? That’s not my point. My point is to encourage those in our industry to think critically, holistically about the problem. My point is to show that transformation will not happen if institutions of health care only pursue solutions with ROI on addressing or avoiding sick care. Digital health, healthIT and health care services startups ought to emerge with solutions that bring about healthier everyday people.
Health care innovators, we need you to help us solve for ways we get to the much preferred “Would You Rather” choices. The sick care industry just has not found its way. Tune in for more on this topic in subsequent posts.