It’s an end of the year thing. What happened in healthcare in the last year that is most important to you as a consumer? It is not good news. Our healthcare system in the United States is a dumpster fire and it did not get better this year. It costs twice as much and outcomes are much worse compared with all other developed countries. Consider these facts from Kaiser Health News: “…our data showing that family health insurance premiums for employer coverage rose 7% to nearly $24,000 this year—and became unaffordable for many workers at small employers — to our series on “Dying Broke” focused on how older Americans struggle to pay for long-term care—the health care affordability crisis continues to plague Americans and remain a top issue going into the 2024 election…. More than 100 million people in America—41% of adults—have medical bills they can’t pay.” That is a threat to every family except for the very wealthy.
The core problem is this. Corporate interests and large health systems have skillfully taken over our system. They make more when healthcare costs more. They have zero interest in keeping you healthy and out of the hospital. United Healthcare is already the largest health insurer in the country, and they already employ or are affiliated with 90,000 doctors. That is ten percent of the doctors in our country. They are aggressively engaging more doctors and they are not advocates for you. They are advocates for United stockholders and executives. Very large health systems employ most of the remaining primary care physicians. I live in Greenville, South Carolina. It is very difficult to find an independent primary care doctor in this area. Primary care that is owned by large health systems or corporations will never give us better health at lower cost. We have had a guidebook for change for two decades but we have done nothing about it. We have made no progress in 2023 towards a system that is as effective and inexpensive as the systems in all other developed countries.
Even more disturbing is the fact that we as taxpayers have spent millions of dollars on primary care research projects over more than a decade designed to improve health outcomes and reduce health costs. These have all failed. The latest, the Comprehensive Primary Care Plus Program, just reported out its results a few days ago. It also failed. I will begin the first of the year with a detailed analysis of the reasons these efforts have all failed.
We can do better. All other developed countries are doing better. A system dominated by corporations, large health systems, and their political allies will never do better. One answer is to demand that your politicians pass laws that serve you rather than the powerful healthcare organizations that make large political contributions. It is a definite thing. You pay more for worse healthcare because of federal government policy. Healthcare cost and quality is one of the main issues that directly affects you and your family. The most important thing we can do to get better health at lower cost is to develop health policies that favor independent advanced primary care practices. If your representative is not willing to make changes that improve your health and lower costs, you should replace him or her.
There is every reason to think that our representatives, healthcare corporations, and massive hospital systems will not make the changes that we need. That said, there is no obstacle to saving ourselves. As I have written before, healthcare is most like water. Everyone understands that all Americans in every town need water and they assure it with a community-owned water supply. You can own a community advanced primary care practice. A local board can govern that practice just like it governs your water commission, and it can determine the priorities for that practice in collaboration with the clinicians. There is a new organization advocating for independent community-owned primary care called Primary Care for All Americans. Every American that joins that organization and every dollar you donate increases the pressure to change our system to serve you better. We can save ourselves. I hope I have a better report for you at the end of next year.
Very good year's summary, Bill. I think you are correct in that the forces of regression and corporate greed gained ground in 2023, not lost ground. We are moving further and further from a public health-based system of medical care, not closer. In the terms of addiction, we have not yet "hit bottom." We know what to do, why to do it, and what is likely to happen if we don't. But we remain as a society in the grip of denial and avoidance of reality. And, I'm afraid that history shows that people without scruples usually win over those with scruples. Things could get much, much worse than they are now. If I could hope for one thing in 2024 it would be for women's health care to improve significantly. This is key to children's health, primary care for the elderly, and public health in general to turn back the tide of repression and profit-based health care. Best wishes in the New Year, David
My system, the UK NHS is dismal it's dominated by bureaucrats and is run for their convenience.
The problem seems to me we want to design a health reward system(s) but we've got illness reward systems.