The Leadership Crisis in U.S. Healthcare
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The senseless murder of Brian Thompson brought the frustration many feel about healthcare to the forefront. Since the shooting, many news outlets have covered the healthcare crisis from a single perspective – insurance companies.
It is essential to step back and recognize what is wrong with our healthcare system. We spend more per person and as a percentage of GDP on healthcare than any other industrial nation. Our outcomes fall at or near the bottom compared to the same countries. Our overall life expectancy is lower. Our infant mortality rate is worse. More of our citizens live with easily treatable conditions.
Some say our approach leads to more medical innovations than in other countries. This is true to a point. We are a leader in healthcare innovation, but our world standing has declined over the last several years. The U.S. now ranks 11th in 2022, down from 4th in 2020.
Many blame insurance companies for everything that is wrong with healthcare. That is short-sighted. The Lown Institute recently published the 8th annual Shkreli Awards, a list of the top ten "profiteering and dysfunction in healthcare." Only a few awards over the last three years were targeted at insurance companies.
There are many players in healthcare.
Providers – Doctors, hospitals, clinics, and all others who care for patients.
Suppliers – Pharmaceutical, medical device, and equipment manufacturers.
Licensing and Certification Agencies – A mixture of federal, state, and industry groups that determine who can practice, the services they can offer, and what drugs and equipment can be used. They review people, products, and facilities.
Standards of Care Organizations – These are a mixture of government agencies, professional groups, and academic institutions that determine appropriate courses and levels of care for every medical diagnosis.
Legislators and Regulators – They pass the laws and write the regulations, which vary widely by jurisdiction, and establish the parameters everyone must operate within.
Buyers—These are the organizations that write the contracts that insurers administer. Medicare and Medicaid are the most notable of the many contracts that federal and state governments write. Private employers negotiate with insurance companies to provide coverage. Each employer negotiates based on its unique demographics and financial constraints.
Insurance Companies – Also known as payers, they negotiate with providers to create networks to administer their customers' plans. They receive claims and process them based on care standards, laws and regulations, and the terms of the individual contracts.
The U.S. approach to healthcare makes insurance companies the only check and balance in the system. This is why patients and family member focus their anger on them when things are not going as they would like.
Many people say that all decisions should be left up to the doctor. This approach ignores two realities. Doctors are not perfect; they make mistakes. When treating a condition they are unfamiliar with, they may not know the current best practice. Not all doctors are ethical. Every year, thousands of insurance fraud cases are filed. A recent article told a horrific story about a doctor in Montana who was diagnosing healthy patients with cancer and treating them for the disease. He became wealthy. The hospital he worked for did not question his methods because revenues flowed in, and insurance companies paid without any pushback.
Our healthcare system needs all its leaders to step up and take on the hard work of reform; perhaps most importantly, we need our political leaders. We need consensus on what reform will look like, enabling legislation and time for new regulations to be put in place.
Changes will only be made with great tact and diplomacy. No one will get everything they want, but they will get enough of what they need to sign on.
Related Articles
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How does the quality of the U.S. health system compare to other countries? | Peterson KFF
US Health Care System Ranks Last Overall Among Other High-Income Countries | AJMC
UnitedHealth Group CEO: America's health system is poorly designed | CNN
Mirror, Mirror 2024: A Portrait of the Failing U.S. Health System | The Commonwealth Fund
"EatWhatYouKill" | Pro Publica
Combating Health Care Fraud: 2024 National Enforcement Action | U.S. Department of Justice
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Quotes
"A compromise is the art of dividing a cake in such a way that everyone believes he has the biggest piece."
- Ludwig Erhard
"If you are not too large for the place you occupy, you are too small for it."
- James A. Garfield
"Once you get past the novelty of a change, you'll find that every system in your organization is set up to reject it."
- David Jones
You can order The Leader With A Thousand Faces on the Recommended Reading Page of my website.
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