How to fix America’s health care
July 2nd, 2013
09:39 AM ET

How to fix America’s health care

By William A. Haseltine, Special to CNN

Editor’s note: William A. Haseltine is president of ACCESS Health International, a non-profit that aims to improve access to health care worldwide, and the author of ‘Affordable Excellence: The Singapore Healthcare Story.

The American health care system is failing. Despite spiraling costs compared with other highly developed nations, the outcomes or results we are getting for all of our expenditures often don’t compare favorably. We spend almost 18 percent of our gross domestic product on health care – an astounding amount of money translating to $2.8 trillion dollars per year. In contrast, Japan spends just over nine percent of GDP; France is below 12 percent; and the United Kingdom spends 9.5 percent.

Some argue that we pay more but get the best health care in the world. Unfortunately, that just is not true – we are most definitely not getting what we are paying for. A recent survey by the National Institutes of Health looked at health care outcomes in high-income countries around the world, and we simply did not measure up. We had the highest rates of mortality for newborns and for children less than five years of age. We had the shortest overall longevity rates, and the highest rates of death from lung and heart disease. There are many other comparisons I could cite, but the unavoidable conclusion is that our system simply does not deliver.

Of course, the health of a nation is dependent not only on the quality of its healthcare system and the skill of its doctors, nurses, and other professionals; it depends also on the lifestyle choices of its citizens. Unfortunately, our citizens are making some bad choices, and the results are all too apparent. Obesity, for example, is at epidemic proportions in our country, bringing with it a host of chronic illnesses.

Zakaria: Why we need to fix health care

According to the Centers for Medicare and Medicaid Services, American health spending will reach nearly $5 trillion by 2021. Now we are talking about real money, outflows of such magnitude that they will cripple our economy and our nation. These costs will threaten our ability to fund our military, maintain or improve our infrastructure, keep Social Security afloat, keep our industries competitive in the global marketplace. They will also increase income disparity, keeping the poor in poverty and preventing the middle class from ever rising higher on the income scale.

Yet, although I have painted a dire picture, I believe that we can avoid this approaching disaster. We can rein in costs and at the same time improve the quality of care in this country.

I am a scientist, and one of the things I study is the way other countries approach health care. Countries like Singapore, South Korea, Japan, and Taiwan have developed systems that are better and less costly than ours. They spend roughly half the percentage of their GDP that we spend on care, yet they are healthier than we are, and their medical outcomes are in many cases measurably better than ours. In science we call that “proof of principle.” In other words, they have proved it can be done – they are doing it over there. Now we have to figure out how to do it here.

More from CNN: U.S. manages disease, not health

So it can be done. The question is, how? What should we do? In looking at successful health care systems all around the world, I’ve come to believe that there are several basic concepts that, if adopted here, can reform and improve the American system of health care.

Higher co-payments for patients. We already have them and we accept them. I would make them higher so that we begin to pay a significant portion of our care out of our own pockets. Raising co-pays would make us all think about what tests, treatments and other procedures we really need. For the first time, we’d think about the cost of our care. The level of co-pay would be subject to a means test and scaled to income. Those with more would pay more, those without would pay less. The irony is that right now we all pay out of pocket without any kind of adjustments or means testing – a multi-millionaire can have the same co-pay as an assembly line worker. We should change that.

Bundled payments to providers. Right now the standard way medical professionals are paid is fee-for-service: the more testing and treating they do for a patient, the more money they receive. That should change. I believe a system of bundled payments should replace fee-for-service. In other words, a reasonable, specific amount of money would go to a provider based on the patient’s diagnosis. The payment would cover all medical treatments associated with the diagnosis. Doing it this way, we would no longer be incentivizing doctors and others to over-treat: they would receive reasonable fees for reasonable treatments.

Price transparency. We can go online and shop for cars, vacuum cleaners, bicycles. We can compare prices, repair records, user opinions. Try that for the colonoscopy or the knee operation you are told you need. It is not possible. We need to move quickly towards easily available published costs for common medical procedures and hospital stays. We need to know what we are paying for, what the costs will be, and whether we would be better off going to a different, less costly hospital or doctor. Singapore does it, as do other East Asian nations. In fact, their systems demand it. We should as well.

Collective, grassroots action. How then, can we begin to reform our health care system – especially now that our nation is divided on so many issues, and Washington seems incapable of rising above partisanship to get anything done?

The effort to reform health care needs to be undertaken at the local level – city, state, and region. Interest groups need to come together to solve the problem: business, labor, local government and taxpayer. All of these groups are being harmed by soaring health care costs, and while there is much finger points amongst them, they are not causing the problem.

In many ways, we are the most individualistic nation in the world, with personal rights and self-interest at the forefront of our national psyche. But In times of crisis, we come together as a nation and our collective needs trump our individualist tendencies. Most often these occur in national security crises, but it does prove that in calamity we begin to understand exercise the power of the collective. That’s what we need now, and to some degree it is beginning to happen.

Business leaders know that the costs of health care are hurting their competitiveness; our state and local governments are beginning – painfully – to rein in the funding costs of public employee health care benefits; our military leaders and concerned about how to provide care for our armed forces in the face of slashed budgets; unions are seeing the damage done to the well being of their members; and the middle class is beginning to understand that they are being held back by the rising percentages of their income they must devote to care.

All of these multiple interests are coming to understand the issue of health care costs must be addressed, and I firmly believe that if they are provided with solutions, they will begin to work towards implementing them.

The choice becomes rationing of care, which no one wants, or becoming more efficient and cost effective. I believe – and hope – that as a nation we will choose the latter.

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Topics: Health • United States

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soundoff (43 Responses)
  1. bocknobby

    Best medicine? Yes. Best health care? No.

    Eventually the US will understand that a profit-driven system, while it may make some individuals wealthy, will never deliver health care to the population.

    As for lifestyle choices . . . make obesity socially irresponsible, like smoking and excessive consumption, perhaps priorities will shift. But all those underlying issues will need to be resolved first. As long as the let-them-eat-cake mentality of the wealthy persists, the problems will persist.

    July 2, 2013 at 9:54 am | Reply
  2. Timmy Suckle

    I kissed my way up to VP at a health insurance company. Now I take over $600,000 of your health care dollars for NO VALUE ADDED to your health care. And that’s just me. Now think about how many other VPs, Directors, Managers, etc. are at my company alone. Now multiply that by thousands of others at hundreds of other health insurance companies. From 10 to 25% of your health care dollars go towards administration that adds NO VALUE to your health care. But my company’s PAC dollars will continue to fool you little people into thinking that a single payer system will be bad. Little people like you are so easy to fool. Little people also don’t realize that a single payer system is the ONLY system that would allow little people (as an entire country) to negotiate better health care prices. Little people don’t realize that the Medical Cartels already know that. And that is the reason why the Medical Cartels spend so much PAC money from the hospitals and doctors lobbying against a single payer system. Some little people say that a single payer system would cost you little people more. But if that were true, then wouldn’t the hospitals and doctors WANT that extra money? Yes they would. So why do the Medical Cartels lobby against a single payer system? It’s because the Medical Cartels know it would allow little people to negotiate better health care prices. And that’s what the Medical Cartels are afraid of. Period.
    But us big wigs at insurance companies, hospitals, and pharmacy companies don’t ever need to worry about health care no matter what it costs. We get our health care paid for one way or another by you little people. And we get the little people that work at our companies to contribute to our PACs. And us big wigs say it’s to protect the little peoples’ jobs. But in reality it would be in the little peoples’ best interest to NOT contribute to the PAC. Again, little people are so easy to be fooled. I won’t ever have to worry about losing my job with so many little people being brain washed by the Medical Cartels’ PAC money. Not only that, the Medical Cartels’ PAC money is used to elect so many republicans that will never allow a single payer system. Republicans have always fought against any meaningful health care reform. But that’s what our Medical Cartels’ PACs pay them for. Politicians can be bought so easily.
    Pretty soon the only people that will be able to afford health care is us big wigs. And that’s the way it should be. We don’t want you little people using up the resources when we need them. And once again, I thank you little people for capping my SS tax at the $113,700 level. Now I only pay 1.2% SS tax and you little people pay 6.2%. Also, thank you for extending my tax breaks. I’m using the extra money on my vacation houses.

    July 2, 2013 at 10:51 am | Reply
    • Jacques

      Very compelling satire.

      July 2, 2013 at 12:20 pm | Reply
    • KPenn

      Thank you. This is a huge part of the problem.. In 20 yrs the number of administrators in health care increased 500%. The
      number of physicians in practice, about 50%. Docs are not the problem. More computers to "monitor" use of services
      does nothing to improve patient outcomes, and certainly does not decrease costs to patients. Doctors do not get paid to
      order tests. Stark laws prohibit getting this!!!

      July 5, 2013 at 9:43 am | Reply
    • tessie may

      Although the poster directly below called your comment "satire" I can very much attest to the truth of what you say. After 11 long years up the ladder (after a lifetime in the medical field in various positions), I was one of the healthcare executives of which you speak. The CEO of my corporation earned >50,000,000 in one year-to be fair, not every year. That does not include the stocks, plane (usually to Washington or the various state capitols), "entertainment" and whatever else was "needed" to get that business. It just mirrored the insanity of any publicly owned company (We can't put at intern in an actual office-they MUST be in cubicles. "Why do you stay at Homewood Suites-that isn't the impression we want clients to have-stay at the Ritz" Yes, I really had that conversation with a VP. We cared only about numbers-with which to impress stockholders. It didn't mean a thing if those numbers didn't really represent anything. The real irony? Our company contracted with states to provide managed care Medicaid/Medicare.

      July 9, 2013 at 4:16 pm | Reply
    • maribeth

      i could cry with relief at someone verbalizing the truth.
      why can't we do something to stop this????
      medicare for all,
      and if a patient chooses to PAY for care OUTSIDE this system they are welcome to it.
      this type of marketplace will self regulate quickly.
      people are VERY VERY adept at shopping!!!!!!!
      the internet is the magic game changer

      July 10, 2013 at 1:15 pm | Reply
  3. JC

    How about revoking the law requiring hospitals to provide care regardless of whether a patient has coverage. Under the ACA there is NO EXCUSE to not have coverage.

    July 2, 2013 at 12:34 pm | Reply
    • Benjamin

      The excuse is I can't afford the roughly 8% effective pay cut that buying health insurance would cost. It's not like me or the rest of the working class have had a raise (in real economic terms) since the 1970s. Maybe if wages had even come close to keeping up with productivity gains, workers could take the hit. But no. Viva la "Reagan Revolution!" The rich got theirs, everybody else flatlined.

      July 2, 2013 at 7:17 pm | Reply
  4. Walter

    How dare you propose higher co-pays. In liberal la-la land, only the rich should have to pay for health care, for everyone else, it should be "free."

    July 2, 2013 at 12:42 pm | Reply
    • Benjamin

      Actually we've had higher co-pays. And higher deductibles. And higher premiums. The cost of health insurance has been increasing WAY beyond the rate of inflation for well over a decade and a half. It goes up when the wind blows. It goes up when it's hot, or when it's cold, or when the Yankees win the World Series or when they don't. It goes up when a Democrat is elected and it goes up when a Republican is elected. Up, up, up.

      July 2, 2013 at 7:20 pm | Reply
  5. JAL

    Ow! My toofs!

    July 2, 2013 at 3:03 pm | Reply
    • TJ

      Sorry, dental services are extra, and not covered by Mediscare or Obamascare. Gotta keep those dentists in Mercedes! :>

      July 3, 2013 at 4:01 pm | Reply
      • tessie may

        This, to me, is one of the fundamentals of true healthcare reform. When/how/who decreed that dentists and orthodontists can charge whatever they dang well please? As new research continues to uncover the myriad ways poor dental health affects total body health, there is no justification for keeping the current dental payment system in place. Dentists should bill and be reimbursed by the same rules that apply to health insurance.

        July 9, 2013 at 3:57 pm |
  6. joe anon 1

    american health care is to die for. american morality is to die for. american ethics is to die for.

    dump your tired, your poor, your huddled losers, yearning to breath, the wretched refuse of your teeming urban blights. send these, the homeless, lied-to to me, i flip the switch at the fema internment camps.

    July 2, 2013 at 4:00 pm | Reply
  7. Benjamin

    We're not going to enact any reforms. The Right has us all huddled together like sheep to support the HMOs and Big Health. Scared to death of SOCIALISM. Never mind that the Berlin Wall fell over two decades ago and that was the last time a Marxist nation posed a serious threat to American hegemony. No. We have to go on paying 10% more every year for healthcare, lest the Soviet Union rise from the dead.

    July 2, 2013 at 7:22 pm | Reply
  8. Ferez Nallaseth, Ph.D.

    Dear Dr. Hasseltine,

    Thank you for this enlightening & interesting article – as well as for the direction to Fareed Zakaria's forum! Allow me to suggest that should the Global Biomedical Sciences Community make a paradigm shift the impact of more than 6000 monogenic diseases costing 10s of $trillions per year could be ameliorated – eventually! Urgency and technical limitations perpetuate the treatment of consequences (pathologies, symptoms, etc..) & ignore the ongoing causes of diseases which are the mutations that escape the networks of Genes regulating Genome & Chromosome biology. A dawning that should have occurred with only a small fraction of decades of work! Without systematizing these mechanisms maintaining Chromosomes/Genomes in Mammalian Homeostasis & Development by including Evolutionary Diversity, Hybrid Zones & Genetics, Histograms, hundreds of Genomic Targets & traditional Science we will not even make a dent on the human & the economic costs! We urgently need the dawning of the age of Functional Mammalian Genomics on a par with dSLAM (diploid Synthetic Lethal Analysis by Microarrays) in Yeast.
    Please visit:

    Best regards,


    Ferez Nallaseth, Ph.D."

    July 2, 2013 at 8:20 pm | Reply
  9. Rick McDaniel

    Obama has created a quagmire, that we will have difficulty extricating ourselves from.

    It is as described........"a train wreck".

    July 3, 2013 at 12:48 pm | Reply
  10. joe anon 1

    single payer health insurance.

    get rid of the parasitic, (un)health insurance companies

    July 3, 2013 at 1:43 pm | Reply
    • maribeth

      i find myself saying that daily!
      Let the monies go to the delivery people!
      Medicare for all
      a marketplace that offers care for cash.

      July 10, 2013 at 1:19 pm | Reply
  11. TJ

    Get rid of "facility fees". Medicare is to pay for treatment, not subsidize hospitals building cathedrals to themselves and jamming the patients (and taxpayers) for the bill. This cut alone would fund a significant increase in payment to primary care phsyicians.

    Level the medicare payment field. Why should Medicare pay different rates for the same procedure based on the geographic location? An MRI of a knee should cost as much in Oregon as it would in Florida, having an appendectomy should cost the same in Los Angeles as it would in Boston. Having Medicare pay a flat fee per study or procedure regardless of geographic location would save billions in unnecessary payments and streamline a ridiculous fee determination process.

    Forbid any facility accredited to accept Medicare patients from charging more than cost (on invoice) + 10% for any durable or disposable medical supplies. This would prevent hospitals from charging patients $100 for a one liter bag of saline that cost them less than a dollar, and so on.

    Those three changes alone would make Medicare solvent for the next generation of patients, instead of being bankrupted by the baby boomers and inept government management of our tax dollars.

    July 3, 2013 at 3:56 pm | Reply
  12. Hank

    Our healthcare system was acceptible until the government decided to "fix" it. Now it is broken and falling apart before our very eyes. Doctors are retiring early or are refusing to take medicair or medicaid patients and their lobbies stay chock full of patients day in and day out with little to no profit in the practice for the doctor(s) who own it. Now, get this. Obamacare is just getting started. He has already decided to hold off its complete implementation until after the 2014 elections. Talk about waiting until it has passed before telling us what is in it has just taken on a whole new meaning.

    July 3, 2013 at 4:19 pm | Reply
  13. ava

    Hank – our healthcare system was like a major train wreck waiting to happen. Obama had the courage to rein in the outrageous healthcare costs, which began in the 1940s and 1950s when physicians changed from population based health care to individual healthcare, because that is where the money is for providers.

    The Affordable Health Care Act has us headed back to population based health care, whereby healthcare personnel (physicians and nurses) focus on preventive care and don't wait for people to get seriously sick. The other countries that the author addresses never deserted the population healthcare model for individual profit. Their physicians and nurses don't make as much money as US healthcare personnel do, BUT they provide a much better service of keeping their populations healthy. Other countries stayed true to focusing on health and not illness. Illness visits is where the money is in the US healthcare system.

    However, every American can do their part to lower healthcare costs by eating a normal intake of healthy foods and exercising. In my opinion, since a third of adult Americans are obese (greater than 30% over healthy weight), we should just focus on the babies and children. Beginning with breastfeeding a baby and not giving formula. Formula is poured into little mouths every few hours, they swallow it in 5 minutes, and their brains haven't had the time to let them know that they are full. Babies can head down that trajectory of obesity beginning in week one after delivery.

    July 6, 2013 at 4:06 pm | Reply
  14. EbonyDelite

    As long as healthcare follows the typical American business model, ie greed, it will never serve the best interests of the taxpayer!

    July 7, 2013 at 1:36 am | Reply
  15. Dirty Harry

    but barry, nancy, and harry all assured us obamacare would give us the best for less? were they lying or just stupid?

    July 8, 2013 at 1:50 pm | Reply
  16. Typo Spotter

    Does nobody else see this typo???
    "our military leaders and concerned about how to provide care for our armed forces in the face of slashed budgets; "

    July 12, 2013 at 12:21 am | Reply









    August 23, 2013 at 8:14 pm | Reply
  18. Eddie Fonseca

    Luther Vandross the late famous soul singer who's voice had that deep base which could make women's heart's and minds, across America and the world melt with his songs on the radio while sipping on a glass of red wine with a roaring fire and the lights turned down low. Luther who belived he could change the world with his music did not realize that the diease diabetes would take at such a young age, in America we lost a great singer who used our great healthcare system to help him live a long life. Just like Luther Vandros who was an average hardworking American who wanted the peice of the American Dream, our nation which suppose to have the world's best medical healthcare system falls short because private insurance healthcare company's make it impossible for hard working Americans to afford health care which in other country's is not a privellge but a right for other people in Canada and in Europe. Being an American who has traveled to other places such as Canada and Europe, their citzens don't have to worry about not being covered when they fall sick because their goverment realize's that healthcare is right for all people not just the wealthy ones as well. There goverments do not make a profit on sick and dying people because in Canada and Europe it is illegal and fundmental wrong as well, so there no aurgments on private health insurance company's when someone is in hospital who will pay the bill they wait till the person is better then the talk about how to pay for their treatment. As Americans we live in nation that is wealthy and can spend money on our great US Miltary provding them with the latest weapons, to hunt terriosts and bad people threating our way of life but when it comes to healthcare there is no money to pay for an average sick American who is sick and dying in hospital. So as hard working average Americans we must ask one simple question, let's imagine this your sick son or daughter who requires treatment but the private isurance company is refusing to pay for it because it's to expensive for them and want to make a big year porfit for their shareholders. So when will we as Americans stand up and say enough is enough and fix our broken healthcare system and let it be universal and free like other people in the world, or will be a nation who is always chasing the all mighty dollar for years to come.

    August 29, 2013 at 9:44 pm | Reply
  19. noyon

    October 31, 2013 at 3:09 am | Reply
  20. Orion

    To fix health care two things are needed.

    1. anyone who is a cash patient should pay hospitals according to the Medicare fee schedule. mandatory fee. Eliminate the two tiered payment system.

    2. Take health care out of the job. Everyone should be buying health care on their own. Level the playing field.
    Employers can pay the difference in cash.

    This would mean starting over with a new type of Obamacare.

    November 23, 2013 at 8:48 am | Reply
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    November 24, 2013 at 1:44 pm | Reply

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