There Is No Silver Bullet

act as a calling card for The Lone Ranger in his adventures. The masked man decided to use bullets forged from the precious metal as a symbol of justice, law and order, and to remind himself and others that life, like silver, has value and is not to be wasted or thrown away.

Wouldn't it be nice if we could do just one thing to fix Sick Care spending? Some think price transparency is the magic bullet. Providing patient consumer customers (PCCs in the new vernacular) with the information they need to make smart purchasing decisions would certainly help, but the worlds of Sick Care and health are complicated places and we need a more comprehensive strategy to fight the inflation beast:

1. Rules drive ecosystems that encourage or discourage entrepreneurs to create business models that create and deploy innovation. Perhaps the biggest rules changes have to do with changing from a fee-for-service model to a value-based model, eliminating employer-based health insurance. But, the FFS beast is hard to tame.

2. Escalating drug prices are an existential threat to risk-based models and need to be restrained. Changing the law to allow Medicare to negotiate purchase prices would be a good start.

3. PCCs have a woefully poor Sick Care, health maintenance, and insurance IQ. Penetrating the veil of medicine is a challenge for even the most experienced navigator.

4. Who and how we train the 21st Century workforce is lagging behind innovative technological, digital health and care delivery models. We are still training graduates to fight the last war and frequently sending them to the front with blanks in their rifles.

5. We continue to misunderstand that spending trillions on Sick Care is treating the symptoms and not the disease. The major impacts on population health have more to do with the effectiveness of non-Sick Care ecosystems, like education, family planning, socioeconomic status, and nutrition and how they are integrated.

6. Major barriers to healthcare innovation. There are 10.

7. Patients can't judge medical quality and they use quality of service as a proxy. Doctors have a hard enough time agreeing on

best evidence treatment guidelines and it is unrealistic to expect patients to do it.

8. The lack of political courage to reign in the national debt, entitlements, and other spending. Medicare, Social Security, Medicaid, servicing the national debt, and defense spending doesn't leave much money for anything else. That impacts directly or indirectly access and the cost of care.

9. The consolidation of wealth, power and influence into a vested few perpetuating the myth that "if only we engaged patients," we could drive down costs on a significant scale.

10. A disgruntled, disempowered physician workforce toiling under the burden of non-value added administrivia and regulatory requirements.

I don't know, kemo sabe, but I think we're surrounded and it will take more than a silver bullet to get us out of this mess.