Fixing American health care: Kissing the frog

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Why is it that our nation has world class tertiary care and spends trillions of dollars on health care, more than any other industrialized nation, but is failing in patient outcomes, cost to the patient, and most recently, a decline in average lifespan. How do we turn this “frog” into a princess, thus offering our nation the care it deserves.

This article will focus on key points that, in this author’s opinion, may pay huge dividends. Topics will include access to care, education, availability of healthy food, and a culture of dependency.

Access to care

Emergency Departments and Urgent Care facilities are overrun with exceptional waiting times and many patients simply leave prior to receiving they care they need. Why is this? One issue is the lack of primary care. Primary care is the cornerstone of health.While not as lucrative a specialty as most others, it remains the backbone of creating and maintaining health. How do we encourage more prospective providers to pursue this avenue. One way is to look to another reimbursement type schedule. The RVU system of payment is often a disincentive to providing good care. This, along with the many administrative burdens, leads to a global burnout of these providers.

An interesting concept is re-inventing the house call. There are a number of our allies in other countries that utilize this system. In the U.S. less than 30% of providers make home visits, and I suspect its even less than that, while more than 67% in a comparison of nine other nations do so. Encouraging home visits would of course require a revamping of the current payment model but would go a long way in terms of accessibility.

Another tool that is underutilized is telehealth. Especially regarding Medicare and Medicaid recipients. While many of these individuals may lack the tech skills needed for our current telehealth models, a simple laptop with one function provided with in-home instruction would suffice.

Education

In spite of our many institutions of higher learning, our population remains “health illiterate”. Health education needs to start even at the preschool level. Healthy foods, diabetes, heart disease, cancer prevention, and dental health, along with reproductive health. This is vital. I am always amazed at the utter lack of education individuals have about their own bodies. Education needs to be ongoing and repetitive. Incentives should be built into the system such as rebates and cost cutting for attending learning sessions and preventative visits.

Availability of healthy foods

Fast food and the snack food industry is huge, as is the advertising that goes along with it. And it is poisoning America. These are often cheap alternatives, while healthy foods such as fresh fruit and vegetables and protein sources seem to be pricier. There is simply no need for this. In consideration of the vast amount of food that is wasted on a daily basis, we need a system of redistribution, cutting waste and making healthy choices available.

There are a great number of “food deserts” in our nation, most of which are in communities of color. In such areas there is an almost 400% increased likelihood of having no supermarket within a reasonable distance compared to other communities. In such areas there is 7x the risk of stroke at an early age, 2x the risk of diabetes and heart disease, and 4x the risk of kidney failure

This is also an area where education for these and for all communities, contributes tremendously. Not only providing guidance about what and how to eat, but even going as far as to educate on home gardening. Such a plan might even spur a sense of entrepreneurism in underserved areas where these food deserts exist. I would envision people growing their own food, even collectively and supplying this produce to the community they live in, sparing transportation cost and ultimately sourcing these goods at lower prices.

Culture of dependency

Our nation was founded with a sense of fierce individualism, a do-it-yourself mentality. Unfortunately, this has morphed into a culture of dependency. We look for local, state, and federal governments to solve our problems. Health care is a team sport. Everybody has a stake in the game. Nothing is free and everyone needs to contribute in some way. Whether it be to pay a small copay, even $5 to $10 dollars, or contribute in other ways. Working as a team in such a way, coupled with improving health care education can result in less burden on the system, reduced cost, and improved health overall. Gone is the “WND” diagnosis, (otherwise know as work note deficiency), and other diagnoses that unnecessarily place strain on the system or, if not gone, one would hope, substantially reduced.

In our current model, we rely so heavily on others. Why does one provider need the help of 3-4 other individuals. Simply due to the stresses placed on us by administration, insurers, health care systems, and pure mindless tasks that are not allowing us to work at the highest level of our education. And in terms of health care cost, this has a tremendous impact. An article in Athenahealth in 2017 chronicles the meteoric rise in cost of care, coupling it with the rise of the administrator. From 1975-2010 there has been over a 3000% increase in the number of administrators! This is in comparison to only a small rise in the number of physicians.

Conclusion

So, how do we tie all of this together, and how do we pay for it? This is a rather simplistic view, however I feel that it has true merit. We simply cannot continue at our present rate. A rate of increasing cost with diminishing returns. The suggestions I’ve made are but a starting point. A beginning that I feel will improve the health of our nation and ultimately reduce cost. With these initiatives, we can decrease late stage disease, the over burden of the entire system, especially the emergency department and urgent cares, and inevitably better the health and welfare of our nation. It is time that we kiss this failing frog of health care and try diligently to turn it into the prince and princess of health.

Vincent A. Cantone, MD, FAAP, FACP, is a double boarded internist and pediatrician with WellSpan in Shippensburg, Pennsylvania. He is currently pursuing an MBA through John’s Hopkins Carey School of Business.

References:

• Johnson,T.,(03/26/2012). “Health care costs and U.S. Competitiveness”,Council on Foreign Relations from Global Economy in Crisis, https://www.cfr.org/backgrounder/health care-costs-and-us-competitiveness
• Hui,A.,(09/20/2022), “With Life Expectancy Declining in Every State, Experts Share Healthy Living Tips”, Health, https://www.health.com/news/life-expectancy-decline-longevity-tips
• N. A. “”Finger on the Pulse:The State of Primary Carein the U.S. and Nine other Countries”, (03/28/2021), The Commonwealth Fund, https://www.commonwealthfund.org/publications/issue-briefs/2024/mar/finger-on-pulse-primary-care-us-nine-countries
• Robbins,O.,(09/11/2020), “From Food Deserts to Food Oases: Addressing Access to Healthy Food”, Food Revolution Network, https://foodrevolution.org/blog/food-deserts-food-oasis-healthy-food-access/
• Cantlupe,J.,(11/07/2017), “Expert Forum:The rise(and rise) of the health care administrator”, athenahealth, https://www.athenahealth.com/knowledge-hub/practice-management/expert-forum-rise-and-rise-health care-administrator