Americans spend more on healthcare than any other developed nation in the world. However, we have poor outcomes than most developed countries. I have repeatedly heard this statement in many major publications, TV, and news. I rarely find an in-depth analysis asking why we are at this point and what has truly happened.
Yes, you can say, its big Pharma, and insurance companies, and yes they do play a major role in it. Putting my economist hat on, the major incentives between the key stake holders in this huge complex which is the government (medicare and medicaid), private insurance companies, hospital systems, and healthcare work force have misaligned interests. At the end of the day, the consumer or the patient in the end suffers. There is nothing new in the argument that I am trying to frame.
So where can we place the blame on this major behemoth ? to be clear, this is a rhetorical question, and there is no right answer obviously.
With the consolidation and corporatization of health care, as part of the advent of private equity, the age of private practice is over. Doctors are overwhelmingly employed by major health systems, where they are lured by sign on bonuses, and fixed income before they become slaves to the RVU productive model, where the bottom line is just volume of care, without much thought given to overall quality. Well, you could say what about all the metrics that are out there.
Goodhard’s Law states that “When a measure becomes a target, it ceases to be a good measure”. The US spends about $3.5 trillion annually on healthcare, which is larger than the entire GDP of India. Per capita, we spend about $12,000. What we forget to think about in all of this, is the entire societal changes happening as part of our chronically sick and aging population, despite all the most amazing modern advances ever made in the last few decades.
The contrast in the healthcare disparities are truly overwhelming, however US does overall a pretty good job in providing advanced complicated care, in the world’s best hospitals. What it lacks is a true grassroots failure of the proactive medicine, that is not only to create a culture of nutrition and healthcare.
With the profit-driven model, everything has been optimized to the efficiencies of scale. This is where we genuinely lack the nuance in the policies that have exacerbated the current epidemic of obesity and metabolic health.
Fast food, and take out food which has been optimized by food scientists to create a dopamine driven loop circuits. Fast foods are the new tobacco for the masses. Alcohol the social lubricant is the addiction for the masses.
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