Fixing: Healthcare Spending and Mayonnaise

Last week, we embarked on a series aimed at addressing the challenges in healthcare. We drew a parallel between the predicament of healthcare and the science of drowning, highlighting the preventability of both. Despite the preventable nature of drowning, healthcare continues to struggle. To learn more, please read here .

Now, let's delve deeper into one of the lessons from last week.

Lesson: We should prioritize what works and refrain from adding elements that may increase expenditure without improving outcomes.

Take a moment to examine the graphic above. It illustrates that we, as a nation, spend more on healthcare than anyone else globally. However, this substantial expenditure does not translate into longer life expectancy when compared to countries that spend only 20% of what we do. This raises a perplexing question: why?

You might wonder how this connects to mayonnaise. Well, it reminds me of a situation my parents faced years ago when they had limited funds. My father, tasked with buying dinner for the week, returned with a case of mayo because it was on sale and incredibly cheap. They believed they were saving money, but they ended up discarding most of it as it spoiled before they could use it all. My mom used to enjoy teasing my dad about this incident.

Now that I've probably left you thoroughly perplexed, let's unravel this story further.

Upon closer examination of the data above, you might think, "Well, this data is a few years old; surely things have improved with five more years of innovation, the Affordable Care Act (ACA), and advancements in technology and digital health, right?" Unfortunately, the reality is that we now spend nearly $13,000 per person per year on healthcare, and our life expectancy is declining , even among infants . If you find the graph above insufficiently explanatory, you can explore this link .

There, you will encounter images like the one below.

It's quite baffling, akin to going to the grocery store and stocking up on more mayonnaise when you have nothing else for dinner. Ironically, we find ourselves in a situation where we're drowning, and what's even more perplexing is that the prevailing suggestion is to keep spending more and more (as if we need more mayo).

Even the American Academy of Pediatrics (AAP) recently expressed a similar well-intentioned hope – the belief that more money and expanded coverage will lead to better outcomes. "The goal is to achieve more equitable, higher quality, and more comprehensive healthcare," explained Jean L. Raphael, MD, MPH, FAAP, a co-author of the policy statement. AAP feels more money needed for Medicaid/CHIP. .

The AAP's stance is not unique; you can find similar calls in various "statements" or "advocacy" letters, all advocating for better payment and more of it for various aspects of healthcare. The AMA thinks doctors should get more pay . The American Hospital Association is also feeling underpaid . Insurers even filed suit to get more payment .

The prevailing irony in our approach to healthcare is that we continue to push for more technology, more payment, and more fragmented, retail-like healthcare solutions, much like adding more mayonnaise in hopes of "providing" a meal. But can a meal truly be satisfying, or healthy, if it’s composed solely of condiments, without the balance of nutritious ingredients that should constitute a well-rounded diet?

If our aim is to remedy the healthcare system, shouldn't our focus be on creating a more balanced 'diet'? It's worth questioning whether our expenditures are effectively addressing our needs or if we're merely pouring resources into a system without assessing its efficacy.

The stark reality is that increasing funds and payments haven't yielded the outcomes or satisfaction anyone desires from healthcare. In some instances, this incessant input of capital might even be exacerbating the problems, contributing to a decline in life expectancy.

Imagine if we put a ceiling on all healthcare spending—halting increases, curtailing lobbying for additional funds, and demanding a tangible return on every investment. Such constraints would compel us to re-evaluate our priorities. With a finite budget, we would be forced to make strategic choices about where to allocate our funds to create the most nourishing 'meal' possible.

To truly mend healthcare, we must reallocate funds towards interventions that are proven effective, cost-efficient, and contribute to our longevity. We need to identify and eliminate financial waste and investments that fail to meet our collective health needs. We ought to handle the healthcare budget with the same frugality and care as if it were our own money—not with the recklessness that comes from spending someone else's cash or the haste driven by fear that if we don't use it, someone else will.

Healthcare once epitomized care, outcomes, patients, and relationships. Now, it seems we're all being force-fed spoonfuls of mayonnaise—thick, cloying, and far from the nourishing sustenance we truly need.

While some love to criticize "value based care," at some point I think we all do need to ask where is the current value in the care we are receiving or delivering? Do we know or care anymore? How do we spend less and improve outcomes?

Maybe first admitting and agreeing that's its pretty clear we are continuing to head in the wrong direction. Agree?

Mayonnaise Mishaps: Simple Spending Lessons

1. Overspending on the Wrong Things: Spending too much on one thing can lead to poorer outcomes and higher long-term costs.
2. Lack of Comprehensive Approach: Focusing only on one aspect can prevent a balanced approach to meeting overall needs.
3. Waste from Excess: Buying too much of one item creates waste, as surplus often expires before use.
4. Ignoring Actual Needs: Not considering the real needs of the end-user can result in buying the wrong items or in excess.
5. Convenience vs. Necessity: The most accessible and cheapest options may not always meet our actual needs.
6. More Money, Wrong Choices: Having more money doesn't mean spending it right; it's about wise, not just more, spending.

Note:?As a reminder this newsletter is written from my experience and perspective.?The newsletter does not imply or relay the opinions of others.??The intent is to offer an avenue for dialogue and discussion around important topics in healthcare and healthcare innovation from one doctor’s perspective.??I am a physician and so can only write from my perspective.?If you are clinician, provider, nurse or whatever my goal is to enable you to agree or disagree.?I have no intention to suggest or imply that only the physician perspectives matter.??They do matter but as part of a larger dialogue that can foster better health outcomes. Edited with ChatGPT

Resources

Healthcare and Drowning

Infant mortality

How has US healthcare spending changed over time?

AMA health care spending

CMS health spend trends

US vs The World in healthcare spend

AAFP take on FFS trends