BY KIM BELLARD
Final 12 months I used a few of Alfred North Whitehead’s pithy quotations to speak about healthcare, beginning with the provocative “It’s the enterprise of the long run to be harmful.” I wish to revisit one other of his quotations that I’d wish to spend extra time on: “The foolish query is the primary intimation of some completely new improvement.”
I can’t promise that I even have intimations of what the completely new developments are going to be, but when any trade lends itself to asking “foolish” questions on it, it’s healthcare. Hopefully I can at the least spark some thought and dialogue.
In no specific order:
Why can we want to spend cash on care when individuals are not wholesome than we do on retaining them wholesome?
The U.S. healthcare system well known for being exorbitantly costly whereas delivering quite mediocre outcomes. Everybody laments it however we preserve throwing more cash into the system that’s producing these outcomes.
We’d be smarter to put money into upstream spending. Like ensuring folks get sufficient to eat, with meals which are good for us. We’d quite spend cash on diabetes or weight problems medicine quite than addressing the foundation causes of every illness. Or like ensuring the water we drink, the air we breathe, the issues we eat, aren’t polluted (what number of toxins or microplastics have you ingested as we speak?). To not point out decreasing poverty, enhancing schooling, or fixing social media.
We all know the sorts of issues we must always do, we are saying we wish to do them, however we lack the political will to attain them and the infrastructure to make sure them. So we find yourself paying for our neglect via our ever-more costly healthcare system. That’s foolish.
Why is every thing in healthcare so costly?
Individuals used to speak about how the army had $600 hammers and $640 toilet seats, however healthcare simply says “maintain my beer” to all these examples. It’s been effectively established that U.S. healthcare’s spending drawback isn’t oversupply or overutilization – though there’s each – however “It’s the prices, stupid.” Whether or not it’s exams, procedures, hospital stays, prescribed drugs, or the rest, in U.S. healthcare issues simply price extra.
But nobody in healthcare thinks their costs are too excessive, and nobody admits they’re making an excessive amount of cash. We’d hoped making sufferers pay extra of their payments, or making costs extra clear, would make them extra worth aware, however that hasn’t occurred. We’ve even recently found that these large well being insurers who supposedly are robust negotiators typically don’t get higher costs than folks paying immediately.
Costs are excessive as a result of nobody cares sufficient to power them to be decrease. That’s foolish.
How come our physicians have gotten extra specialised regardless that we’re realizing how interdependent every thing in our physique is?
Major care docs make up at most only a third of U.S. physicians, a proportion that’s each declining and effectively under the comparable proportion in different developed international locations. Furthermore, the physicians who’re specialists are increasingly becoming sub-specialists. That’s nice in case you have just one very particular well being concern, but when that concern is just one of many, or if that concern is because of or has created different well being points – as is probably going – then it isn’t so good. It means a number of referrals, many docs, and typically conflicting suggestions, Major care docs have been speculated to coordinate every thing, however, as I stated, there aren’t that a lot of them, they usually don’t have the time anyway.
If we would like extra holistic care, we’re coaching physicians fallacious, we’re incenting them fallacious financially, and we’re not getting anybody with the massive image of our well being. That’s foolish.
How come there isn’t any one within the well being care system whose job it’s to maintain us wholesome, and who’s rewarded accordingly?
Everybody in healthcare talks about wanting sufferers to be wholesome, and lots of of them pay at the least lip service to reminding you about doing issues which may assist, however let’s be clear: they receives a commission while you get sick (or, at the least, use providers). It’s not a well being system in any sense; it’s a well being care at greatest, and, extra precisely, a medical care system.
In case you have one, a major care physician would possibly declare to fill that area, however, admit it, they don’t actually know what your well being habits are and have little potential to affect them. Arguably, there are an ideal many well being behaviors which are exterior physicians’ coaching and experience anyway. The well being care system thinks about folks solely once they change into sufferers, and primarily depends on reactive, medical interventions to handle well being points.
Hypothetically, one can think about a well being care system by which you pay for the durations throughout which you might be wholesome, and don’t pay while you aren’t. As a substitute, we use a system by which the extra you employ it, the extra you pay. That’s foolish.
Since we’ve found that our microbiome outnumbers “us” – by way of cells, DNA, and many others. – and has direct impacts on “our” well being, why does our well being care nonetheless deal with “us” and never on “we”?
It was an enormous step ahead for medication, and our well being, once we found micro organism, viruses, and many others., however we shortly determined they have been the enemy and declared struggle on them. Sure, advances like penicillin have saved numerous lives, however, as with many advances, we didn’t absolutely perceive the results.
To the extent we take into consideration our microbiome, it’s normally along side our intestine, and largely solely in relation to our intestine well being, however analysis is exhibiting that the intestine microbiome impacts different areas of the physique (such as our brain), and that our microbiome has impacts on almost all aspects of our health. Our vaunted theories of illness badly want a 21st century, microbiome-inclusive replace. Prefer it or not, if it isn’t not wholesome, we’re not wholesome.
We indiscriminately kill off “good” microbes together with the “dangerous” ones, quite than attempting to optimize the stability. That’s foolish.
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Our well being care system has a “The Emperor Has No Clothes” drawback. Many people understand that it’s badly flawed, even perhaps irredeemable, however it’s the system we’ve, and we determine that it will take an excessive amount of to basically change it. Effectively, that’s foolish.
So I’ll preserve attempting to ask foolish questions on healthcare and hope that others can get intimations of one thing completely new.
Kim is a former emarketing exec at a significant Blues plan, editor of the late & lamented Tincture.io, and now common THCB contributor
