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02/04/2013

The problem with health care is…


Last October, one year after his death, his biography by Walter Isaacson gained critical acclaim and sparked intense interest in the iconic life of Steve Jobs. The story will be a documentary soon and has all the elements—early childhood challenges, business successes and failures, family pressures, interpersonal intensity, and an insatiable passion for technology-enabled solutions.

I read the book and one theme jumped out: Steve Jobs knew the principle of simplicity—the power of building simple solutions to solve simple problems.

Some believe that the problems of health care are too complex to be solved. I disagree. They’re simple. At approximately $9,000 per capita, our health system is under-performing. No excuses. We spend more than any other country on the planet, but operate a system no one understands, and its costs are threatening our long-term economic survival. There’s plenty of money in the system. That’s not the problem.

Proposed solutions, regrettably, focus more on tweaking the status quo than fixing the problem. Understandably, each health care sector views its role as central to the solution, and all other sectors complicit to the problem. Though controversial, the Affordable Care Act (ACA) provokes cross-sector collaboration between providers and payers and increased transparency about the system’s performance at every level. It’s far from perfect, but in my view, there’s more in it that makes sense than not. But a simple solution is needed. Our surveys show employers1, physicians2, and consumers3 know little about the ACA, but have strong opinions about various elements where they’re attentive…

Employers worry about health care costs and think the ACA does little to contain them.1 The health insurance exchanges (HIXs) might offer an alternative to employer-sponsored coverage, but it’s too soon to know. Meanwhile, the issue is cost and the ACA is not understood to offer a simple solution!

According to our survey, physicians worry about their profession in areas such as clinical autonomy, compensation and prestige. Lacking a fix to the Sustainable Growth Rate (SGR) and medical liability, some physicians reason the ACA falls short of a simple solution.2

And consumers: the vast majority does not know what’s in the ACA or know much about the health system at all. They filter noise about health reform through the lens of personal experiences with the doctors, hospitals, and insurance plans they use, and the products and services they buy in retail and online services. Many consumers don’t understand the simple problems of the health system, much less a range of simple solutions.3

As we enter an important series of discussions about our long-term debt and the costs our kids and grandkids will face if deficits are left unaddressed, we should take advantage of this important moment in time and educate the nation about our health system—how it is structured, how it operates, how it’s regulated, how it generates income, how it impacts jobs, communities and global health, and how it creates value.

Only then can we move from sectarian rhetoric that contributes to confusion to systemic transformation of a system that’s 24% of the federal budget, 21% of the average state’s budget and 19% of discretionary spending in the average household.

We’re nowhere close to finding the simple solution because we have failed to educate our fellow Americans about our health system. It’s that simple.

Read the entire Health Reform Monday Memo here and subscribe at: www.deloitte.com/centerforhealthsolutions/subscribe

by Paul H. Keckley, PhD, Executive Director

Deloitte Center for Health Solutions

Sources:

1 2012 Deloitte Survey of U.S. Employers: Opinions about the U.S. health care system and plans for employee health benefits

2 2011 Physician Perspectives about Health Reform and the Future of the Medical Profession

3 Deloitte 2012 Survey of U.S. Health Care Consumers: The performance of the health care system and health care reform

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