We are going to need a bigger boat – the health care blog

By Kim Bellard

My friends, we are like explorers of yesteryear standing at the edge of a known continent, looking at the vast ocean in the hope of finding new lands, intact and better. Admittedly, we may have moved the continent behind us, but things will certainly be better in the new lands.

In the metaphor I think, the known continent is our ruin of a health system. For all protests on the United States with the best health care in the world, it is obviously false. We do not live so long, we have more chronic diseases, we have been killing ourselves and ourselves at alarming rates, we pay much more, we have too many people who cannot allow ourselves to take care and / or not obtain care, we have too much care that is ineffective, inappropriate or even harmful, and we spend much too much for administration.

We do not trust the health system, we do not think that its quality of care is good, we have an unfavorable opinion on this subject, we think that it fails. The vast majority of us think that it should be fundamentally modified or completely rebuilt. This is what we want to flee, and it is not surprising why.

Through this metaphorical ocean, in the distance, on the horizon, is on the 22nd^ND Century health system. We hope, we hope, like magic. It will be more equitable, more efficient, more efficient, more proactive, less invasive, more affordable. We do not know exactly what it will look like or how it will work, but we have seen what we have, and we know that it can be better – much better. We just need to get there.

This brings me to the next part of the metaphor. I recently read a large quote from the writer Feu Nature Barry Lopez, his posthumous test book Embred the burning world without fear. Mr. Lopez deplores: “We are looking for the boats that we have never built.”

The boats do not come to save us, to transport us to this idealized 22^ND Century health system. Because we have never built them. Because we always Do not have the courage to build them.

We have never built a system to ensure universal coverage. We count on a meli -melo of coverage mechanisms, each of which is struggling with their own problems and always leaves some 25 million people without insurance – and it is before the 10 to 20 million which should lose the coverage due to the “large and beautiful bill” – as well as the tens of millions of people who are “under -assured.

We have never built a system that was at a fair distance, just as we have never done for housing, education or employment. Money counts, ethnicity is important, geography is important. The differences in availability of care and results appear clearly for each of them, and more.

We have never built a system that prices especially patients. We have referred to doctors and hospitals, not calling them when they gave us lower quality or when they billed us too much. Health care has now gone from a “noble vocation” to a creator of jobs and wealth. A recent New York Times Analysis found (among other things):

• Health care is the largest employer in the country;
• In 1990, health care was not the largest employer of any state; Now it’s in 38 states;
• We spend more in health care than for grocery store or housing.

Choose your favorite objective: investment capital companies that buy health care entities, for-profit companies that extract profits from our nominal “non-profit organizations doing the same), stable corporatization of health care. Add favorite boogeymen such as health insurers, PBMs or large pharmaceutics. In one way or another, it is money, not us.

The adage on Big Tech comes to mind: we are not the customer, we are the product (or, as I have already written, we are simply the NPCs.).

We have never built the systems to facilitate administration. So many codes, so many rules, so many types of insurance, so many silos, so many administrators. Now you have undoubtedly seen the Table of the Growth of Administrators in relation to the clinicians of our health system, and know that about a quarter of our dollar health goes to the administration. This should not be so, it should not be so, but the administrative bloating empires, no better.

We have never built the systems to correctly follow our health or our risks.

From wastewater monitoring to monitoring diseases / epidemics to the negative impacts of prescription drugs, medical devices, we count on random methods that do not leave us effective warning systems. The various public health mechanisms that we had in place were terribly funded before the covid, crashed (and were burned) during the cocoat, and are now happily funded.

Worse, we have never built a system to follow what care really works. Of course, there are gold controlled studies that are supposed to do so, but a lot of care that is provided are not based on such studies, the impacts of these studies take years to permeate real practice models, and practitioners are not really monitored to ensure that they provide “good” care or “good” way. We submit to the care, we pay for this care, without really knowing if it is the care that we should receive or the person / institution that should give it to us.

Shame on us and the system that allows all this.

Without building all these boats, we do not arrive at 22^ND Health system of the century we want and deserve.

Of course, there is a lot of exciting technology that will help do things look More like a 22^ND Century health system. AI, robots, genetic montage, nanobots, intelligent cells, synthetic biology, and even more – they are all exciting, and will all be useful in this 22^ND Century Healthcare. But they will not bring us to 22^ND Health system of the century that we should obtain. They will just take us into a smoother and more expensive version of the one we have.

You may have seen a few weeks ago was 50^th anniversary of the initial exit of Jaws. One of his most emblematic lines was the reaction of Chef Brody when he saw the size of the shark that he and two companions stammered stupidly: “You are going to need a larger boat.”

When it comes to bringing us to 22^ND Health care system of the century we should want, we will also need a larger boat – and we will better start building it NOW.

Kim is a former Emarketing leader in a major blues plan, editor Dye.ioand now a regular THCB contributor