Playing games with the American health-care system has fragmented it to the point that it is not cost-effective, efficient or fair.
Half the time, patients do not get best-practices treatment.
One-third of the medical expenses are unnecessary, counterproductive, or harmful to the patient.
Despite spending 16 percent of the nation’s gross domestic product on health care, our infant mortality is rate is more than twice the rates in Sweden, Japan and Hong Kong.
We as a society have not established an overall vision or goal for our health-care system. Many diverse interest groups jockey in a system too complex to control without a plan, but planning is difficult because the involved groups have such different agendas.
The interest groups bring different languages and perspectives, and there hasn’t been enough common ground to build a consensus. They are not even playing the same game.
For example, Wall Street (one of the the newer players in health care) looks at the health-care table like a Monopoly game. A large health-care business may have bought two railroads (hospital systems), one utility (physician practices) and five different properties (some drug companies). But it doesn’t have any monopolies. They came to health care because there are trillions of dollars on the table, and they see potential profit. Their due diligence didn’t consider that the government does have available, even if unused, a monopoly on the payor side and could someday set payment rates.
The government has a seat at the table – a very large seat, because it pays for the majority of health-care services. This dominant position could allow it to set payment rates. But it doesn’t, and it doesn’t really monitor whether it’s getting good value or quality for the money. The government thinks the game is a lottery and buys most of the tickets but never checks to see if it won.
Health-care providers struggle in the game because they don’t know if they are selling a service in a free market or whether they are providing a public utility. To them the game looks like Chutes and Ladders.
The insurance companies are willing to allow the Wall Street people to think the game is Monopoly, as long the insurance business gets to be the banker. The rest of the time they treat the game as Clue. Employers have to guess which plan is best for their employees. The providers have to guess how to get claims paid through the system. Patients have to guess about clinical effectiveness and financial risk. The insurance companies speak a different language than everybody else.
Also at the table are the drug companies. To them, the game looks like poker. They look at the chips sitting in front of the other players and think if they bet enough (invest in research and development), there will be a payoff at the end of the day.
Medical consumers are sitting in the audience and don’t even have a seat at the table. They abdicated their responsibility to their employers. Now health savings accounts are giving some consumers choices, but they don’t have the information they need to make good purchasing decisions. It looks like a television reality show to the consumers.
Employers don’t want to be at the table. They used health-care benefits to work around wage limitations three generations ago and have been stuck ever since. They abdicated their responsibilities as informed medical purchasers to the insurance companies, brokers and providers. They think the table looks like a dice game. They keep putting money in, but some one else is rolling the dice.
It’s past time for our society to establish rules and goals for the use of health-care resources, and to make sure everybody at the table is playing the same game. There are too many different ones being played now, and almost everybody is losing.
Carl L. Smith lives in Fort Collins and has worked in a variety of positions for insurance companies and hospitals.
