We have known how to produce better health at lower cost for years, and we should let our politicians know that rapid movement in that direction must be a national priority. Over the last week, I have provided links to great articles that document the sad state of our healthcare system. This is nothing new. The National Academy of Medicine exists to provide policy advice to the government and other stakeholders. Twenty years ago, they described a broken health system that did not serve the evolving needs of our population. They called for major reengineering of our healthcare system to reflect the fact that most death, disability, and cost comes from chronic disease. Very little has changed since that landmark report. Our system deals with expensive complications late, and fails to provide optimal medical treatment that prevents those complications early.
Disadvantaged people are much more likely to develop type 2 diabetes and high blood pressure early in life. They frequently have no health insurance or inadequate coverage. Patients on Medicaid run out of test strips needed to manage insulin injections. That leads to poor sugar control, expensive emergency room visits, and costly complications like dialysis, stents, and amputations down the road. Forty-two percent more Americans die of diabetes compared with other developed countries. We don’t pay early for relatively inexpensive advanced primary care, but we pay dearly for the late complications of neglect. We don’t pay to treat high blood pressure and diabetes that cause kidney failure. As soon as the patient goes on dialysis, we pay. It makes no sense, and it costs us all too much. Even if you are young, and perfectly healthy, you are paying more in insurance premiums and taxes than you would in a better system
Despite a mountain of evidence proving that expensive spine, knee, and vascular surgery offer no benefit beyond conservative care in most situations, unnecessary medical procedures are still very common in the United States. In fact, in our money-driven healthcare system emphasizes the invasive procedures and have not developed the best practice conservative measures. Patients with stable heart artery disease will get their stress tests, heart catheterizations and stents. Very few get the optimal medical treatments that are so effective. It does not have to be this way.
You are not getting your money’s worth in the American healthcare system. The choices we have made have consequences. Almost 20% of all spending in the United States goes to health care. The SouthCentral Foundation in Alaska cut that in half. Europeans live longer for 10% of all spending. People in Singapore live longer for less than 5%. Singapore took the advanced primary care principles of the SouthCentral Foundation and applied them to the high-risk, high-cost people with chronic disease. I am convinced we can do even better, but we can’t get there without the reengineering that the National Academy of Medicine called for.
The COVID epidemic has proven too many Americans don’t trust their health care system. I don’t blame them. The sad truth is science has advanced so much that we could live longer healthier lives now. If we got the money people out of the way, we could have longer lives, better health, lower cost, and we could cover everyone—like other advanced countries do. I learned two things in medical school that really stuck with me: A physician must be an advocate for his or her patient and “first, do no harm.” Our healthcare system is focused on money, and it is harming people every day with sins of omission and commission. I am 74 years old. My days of scrambling to get a leadership position are over. I have no conflicts of interest. Here is my commitment to you. I will continue to work hard to identify best practices and solutions to the American healthcare crisis. I will review the evidence and then I will pass it on to you so that we can work together to enjoy the benefits people in other advanced countries have. I will work hard to determine what the truth is so you can help clean this mess up. Please help your family, friends, and neighbors understand and join the fight!
Yup! Agreed! We started the journey to fundamentally change the course of cardiovascular health management nearly 25 years ago!!!