Earlier this month, presidential candidates presented big ideas for health care. So far, their ideas have been about different ways to finance our broken system, not how to fix it.
In a new Johns Hopkins study, my colleagues and I found that 48 percent of all federal spending goes to health care in all its hidden forms — enough to give everyone in America gold-plated care. Remember that statistic next time you pay your taxes.
We just need to cut the waste and ignore the echo chambers of cable news telling us we’re a divided nation. The path out of our health care mess is embarrassingly simple and has broad American support:
Imagine if travel sites had no prices for flights and airlines billed you after the flight, arguing that they can’t know ahead of time if a flight will be delayed or if you’ll consume a beverage. Price opacity enables price gouging. In every industry, transparency keeps prices in check, even if only a fraction of shoppers use pricing information.
Find a patient-centered
Doctor Coding, billing and clicking through electronic health records instead of spending time with patients is why physician burnout has reached record levels. A new generation of relationship-based clinics is now disrupting that current broken model. They are recommending cooking classes to treat diabetes and rejecting the old reflex of treating back pain with surgery and opiates instead of physical therapy and ice. These clinics are paid in lump sum by Medicare Advantage or employers and are addressing the root causes of disease. They have already delivered a 15 percent savings to Medicare, caring for the poorest and sickest patients in America.
Get rid of the middlemen
An estimated 30 percent of health care goes to things that have nothing to do with health. As we doctors practice medicine, a massive back-room industry has grown, buying, selling and trading our services on the grid like energy. Not only is it costly to staff this behind-the-scenes business, but the game of hospitals negotiating secret discounts to insurers prevents competition.
Brokers who sell pharmacy plans and health insurance to American businesses are paid a 4 percent commission on all health-insurance premiums in perpetuity. They are often also paid kickbacks from the pharmacy plan (eloquently called rebates) and insurers. As a result, businesses are not always getting the best options, a striking parallel to the subprime mortgage-broker industry pre-2007. Similarly, middlemen called “group purchasing organizations,” who sell drugs and devices to hospitals, receive kickbacks that would be illegal if it weren’t for a 1987 “safe harbor” law that created an exemption for health care. It’s time to ban all kickbacks in health care.
An estimated 21 percent of all medical care is estimated to be unnecessary, according to a national survey of physicians, including 25 percent of diagnostic tests, 22 percent of medications and 11 percent of procedures. Using physician-developed ways to measure and capture appropriate versus inappropriate treatment, rather than hammering doctors with insurance pre-authorizations, is already showing promise. The Improving Wisely approach, which sends a confidential “Dear Doctor” letter to outlier physicians letting them see where they stand relative to their peers, has already shown promise in reducing overtreatment and saving millions to the system.
While the medical industrial complex fuels the political debate on how to pay for health care, the real choice is whether we can stand up to the special interests and reform our current system in areas where there is broad consensus. Health care’s $3.5 trillion bloated economy is unsustainable. It’s time we cut the waste and restore medicine to its mission.
Marty Makary is a Johns Hopkins professor and author of the new book “The Price We Pay: What Broke American Health Care and How to Fix It” (Bloomsbury Press), out now.
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