Why is making healthcare easy so hard?

Well, the simple answer is there are too many players and partnerships between them are next to impossible to broker. In order to fix the healthcare experience we all hate, the partners must have a singular vision for a better experience, and then broker the deal so we all benefit. 

There are a four main players in healthcare:

  • Employers
  • Health insurance companies
  • Doctors/Hospitals
  • Patients

Employers want a healthy and happy workforce for an affordable price. Doctors and hospitals want to fix illness and make a profit. Health insurance companies want to calculate risk, manage risk, and make a profit. And patients just want a doctor who will help them either optimize their health or get better.

Presently, for the most part, employers are responsible for paying for health. Employers purchase health insurance for their employees. They of course know it’s in their best interest to have a healthy workforce. Healthy workers make their business better.

But the challenge here is creating an ecosystem of disruption that markedly changes healthcare for the better. In order for healthcare to be “disrupted” and made into a completely better experience, we’ve got to have an ecosystem of disruptors all playing on the same team with the same goals— disruptive employers, disruptive health insurance companies, disruptive doctors/hospitals, and disruptive patients. The chances of that happening are quite slim.

So let’s follow the money. It all starts with the employer. They’re, by far, the ones shelling out obscene amounts of money on ever-increasing health insurance premiums. They are the ones that can start this disruptive ecosystem. The forward-thinking companies, who are disruptors themselves, are the ones who need to think differently about healthcare.

It’s in their DNA.

Obama’s plan started with good intentions. But in the end, it ended up being a compromise that essentially puts the medical industry on life support. It’s prolonging the death of a completely unsustainable industry. Let’s look at the average cost of yearly health insurance premiums over time:

2001: $4,918

2009: $10,743

2019: $28, 530

These numbers are an undisputed fact. By the end of the decade, premiums will be, on average, just shy of $30,000. Obamacare does very little to control costs. Remember, almost everything about this Act is a compromise with the incumbents to maintain the status quo as much as possible. And that status quo is unsustainable. Even with Obamacare, the premiums are still going to rise to nearly $30,000 by the end of the decade. 

I think now is not the right time to put a dying industry on life support. We need to think long term. And the only long term sustainable solution for the medical industry is a single payor healthcare system. There is simply no way, in a country as large as ours, to link profitability to sickness. And Obamacare, by mandating us as individuals to purchase healthcare from a private industry beholden to it’s shareholders, simply prolongs an unsustainable industry.

I think healthcare reform, and I mean fundamental reform, can only happen when everyone’s feet is held to the fire. And that’s going to happen toward the end of this decade, when individuals and companies en masse, realize they can’t afford even the average premium. And that’s the right time to fundamentally change the entire business model of healthcare in America. When people aren’t under the gun, compromise is the easiest way out. But compromise amongst industry insiders won’t solve the fundamental problems we face trying to take care of the health of our population. Trial by fire is probably the only way.

We need a completely different system— a single payor that profits off wellness, not sickness. We’re simply not going to get that by placing a broken and unsustainable system on life support. If I felt that Obamacare was a good first step toward a sustainable system, I’d support it. But the shit is going to hit the health insurance premium fan in the next 7 years, and I have no faith that more compromises amongst industry insiders will get us toward a sustainable single payor system. 

I think the real “success” of our modern American leaders is giving all of us, especially minority groups, just enough rights to shut us up. That’s what’s happening with healthcare too. In seven years, they’ll look out at the population and tout stats that say we’re better off. But, in reality, over the long term, we’re worse off. The leaders deciding my long term health and financial status will be dead and gone when our healthcare system is beyond bankrupt. And their selfish focus on short term compromise instead of long terms gains makes me furious. And for that reason, I’m not a fan of Obamacare and I hope SCOTUS overturns it and lets us have a trial by fire in seven years, hastening a much quicker transition from a medical industry to a single payor, sustainable healthcare system.

But we seem to want to be free from that obligation as well. This morning in America’s highest court, freedom seems to be less about the absence of constraint than about the absence of shared responsibility, community, or real concern for those who don’t want anything so much as healthy children, or to be cared for when they are old. Until today, I couldn’t really understand why this case was framed as a discussion of “liberty.” This case isn’t so much about freedom from government-mandated broccoli or gyms. It’s about freedom from our obligations to one another, freedom from the modern world in which we live. It’s about the freedom to ignore the injured, walk away from those in peril, to never pick up the phone or eat food that’s been inspected. It’s about the freedom to be left alone. And now we know the court is worried about freedom: the freedom to live like it’s 1804.

Supreme Court and Obamacare: why the conservatives are skeptical of the Affordable Care Act. – Slate Magazine (via kbaum)

Actually, in addition to there being a sense of community, it’s more about the federal government mandating individuals purchase services from private entities that are beholden to the shareholders’ interests, not my interests. I would not have a problem with this law if it mandated the purchase of a public insurance plan, essentially Medicare for All. But the law doesn’t due to politics and compromise. And because of that, it’s much more about fundamentally changing the individual relationship to the federal government. 

This is not about interstate commerce. It’s only interstate because the health insurance companies have merged with one another and restricted our options so much, that the health insurance companies are now nationwide. 

The real question is this. What’s the smallest group of people that can come together and effectively cover themselves from financial protection due to medical bills? The answer is 1500. If we could scale back health insurance companies so that they’re not interstate, but intra-neighborhood, or even intra-city, we’d solve many problems including the community issue raised above, but also the interstate issues that have arisen because the health insurance companies are too big to fail.

Which alcoholic drinks are “healthiest?”

You don’t want pull out your calorie calculator next time you saddle up to the bar, so with all that out of the way, you’d probably still like some more specific directions. So let’s talk brass tacks:

  • Drink wine. It’s low in calories.
  • Drink liquor. By itself. It’s low in calories.
  • If you can’t do without your mixed drinks, consider diet tonic, sodas, juices, etc. WebMD offers this list of low-calorie mixers.
  • If diet mixers aren’t an option, most martinis are low on calories (apart from the obvious, like chocolate martinis)
  • Gin and tonic is not bad (around 200 calories), but the tonic can add up fast.
  • Generally speaking, “light” beer has fewer calories than a traditional lager, which has fewer calories than an ale. For most beer lovers, that basically means flavor is directly proportional to calories.
  • If you want to faceoff your favorite drinks, head over to web site Get Drunk Not Fat.

The Future of Primary Care.

Let’s consider a few facts:

  • Only about 5% of graduating medical residents chose primary care as a profession for the past decade or so
  • Primary care doctors earn $3.5 million less over their careers than specialists
  • About 70% of primary care visits get referred to specialists
  • About 60% of traditional primary care visits can be done over the phone or over the internet
  • The average primary care visit is less than 8 minutes
  • Patients forget 85% of the information told to them in an 8 minute visit

Nobody is going into primary care because the pay sucks and the traditional old-school notion of office-based primary care is the wrong tool for the lifestyle-based health problems that plague our culture.

The future of primary care is a completely different process. Primary care will be about communication (90% via messaging, 10% via phone), problem-solving, and triaging to match the individual up with the right professional at the right time. Primary care must have real time access to available local resources. For example, when we get a call from a patient with a cut finger, we need to go to our group of professionals who can stitch that up and see their real time availability. It’s communication and coordination and matching up local demand and local supply. Primary care needs a “God-view” dashboard of ER wait times, ER availability, specialty centers, specialists, urgent care centers, etc. It also needs technology that functions more like a CRM like Highrise mixed with a customer service system more like Zendesk, but of course, designed for medical care. 

Problems need to be triaged. We’re finding that about 50% of the problems coming in to Sherpaa can be handled without a doctor. Those problems that need a doctor are then sent to our dedicated virtual Primary Care Physician— a doctor available 24/7 via email or phone to solve the clinical problems that can be handled without a physical visit. And, for the rest of the issues that absolutely need a physical visit, we triage to exactly the right available expert who is best suited to solving the problem at hand. For Sherpaa, it looks a lot like this:

The primary care doctors have different roles— they emphasize communication and virtual problem solving rather than maximizing revenue from 8 minute office visits. Think of it like 311 for healthcare, but manned by local doctors with local connections to available resources. This is the future of primary care. It’s a whole different process. It’s a whole different experience. In fact, for patients, it’s a markedly better experience. Just give 311 a call. You can talk to a human in seconds. Imagine a system where you can talk to a local, super well-connected doctor in no time, exactly when you need it. Sounds wonderful doesn’t it?

Photo from Eugene Smith’s Country Doctor series