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.

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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.

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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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soundoff (45 Responses)
  1. 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
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    October 31, 2013 at 3:09 am | Reply
  3. 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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