The sick care Machine underserves and overlooks everyone
Arlen Meyers, MD, MBA
President and CEO, Society of Physician Entrepreneurs, another lousy golfer, terrible cook, friction fixer
Access to sick care in the US is not equitably accessible. Those who are the most adversely affected are called "underserved communities".
According to a Presidential executive order, (a)? The term “equity” means the consistent and systematic fair, just, and impartial treatment of all individuals, including individuals who belong to underserved communities that have been denied such treatment, such as Black, Latino, and Indigenous and Native American persons, Asian Americans and Pacific Islanders and other persons of color; members of religious minorities; lesbian, gay, bisexual, transgender, and queer (LGBTQ+) persons; persons with disabilities; persons who live in rural areas; and persons otherwise adversely affected by persistent poverty or inequality.?
(b)?..“underserved communities” refers to populations sharing a particular characteristic, as well as geographic communities, that have been systematically denied a full opportunity to participate in aspects of economic, social, and civic life, as exemplified by the list in the preceding definition of “equity.”???
The shift helped deliver the White House to Donald Trump and could continue to alter the political landscape if more Americans identify themselves less in the context of race and gender and more as belonging to a certain economic class.
Given its collective wealth, technologic sophistication, and spending, the United States should lead, not lag, the world in its healthcare performance. But based on 70 performance measures across five domains — access to care, health outcomes, administrative efficiency, care process, and equity — the United States came in last overall and last or next to last in four of these five broad areas of performance when compared to nine other high-income countries. Significant, but doable, changes — including closing remaining gaps in insurance coverage, limiting crippling out-of-pocket-expenditures, and reviving its failing primary care capabilities — would help close the gap
Many non-profits and organizations have diversity, equity, and inclusion programs to address the needs of underserved communities which has further fueled our culture wars.
Some feel many of these programs are misguided. One reason is sick care USA underserves everyone, even the 1%
Nothing is more entertaining than talking about the myths of the US Sick care Inc.
1. The US healthcare system is actually about keeping people healthy. In fact, it is a system of sick care systems designed to take care of sick people, not keep them healthy.
2. Having insurance means having access to care
3. Doctors are willing and able to treat patients and provide access to care regardless of who is paying them and how much.
4. There is one US healthcare system. In fact, there are at least three tiers-mass care, middle care and 1% care and there is likely to be for the foreseeable future.
5. Medicare and Medicaid payments can increase as much as voters want them to without any impact on our national debt or global competitiveness.
6. All patients will get the same access, outcomes and experience.
7. Most of what doctors do will be replaced by robots, machines and software, so why worry about any predictions of a manpower shortage.
8. There will always be an abundant supply of undergraduates willing to ride the student debt bubble to be a doctor.
9. Social Security, Medicare, the VA and other vested interests are immune from substantive change and will remain third rails. The only?time you can touch them is when they break and you don't have to worry about getting electrocuted.
10. The clinical half life of the average full time doctor will be the same as it has been for the past 100 years.
11. US medicine is not a business
12. The ethics of business are the same as the ethics of medicine.
The United States ranks last among 11 countries in the Organization for Economic Cooperation and Development (OECD) in terms of health care access, care process, administrative efficiency, equity, and health care outcomes . Despite spending more on health care as a share of the economy, the U.S. has the lowest life expectancy and highest suicide rates among the nations studied .
For the first time in Gallup’s two-decade trend, less than half of Americans are complimentary about the quality of U.S. healthcare, with 48% rating it “excellent” or “good.” The slight majority now rate healthcare quality as subpar, including 31% saying it is “only fair” and 21% -- a new high -- calling it “poor.”
An estimated 112 million (44%) American adults are struggling to pay for healthcare, and more than double that number (93%) feel that what they do pay is not worth the cost. The findings come from two new composite scores developed by the nonprofit, nonpartisan organization?West Health ?and?Gallup , the global analytics and advice firm, to assess the healthcare cost crisis.
Out-of-pocket costs for patients with health insurance are rising . Deductibles have quadrupled over the past 12 years . The share of out-of-pocket costs paid by patients with employer-sponsored health plans increased from 17.4 percent in 2013 to 19 percent in 2019.
Approximately 78% of the U.S. population receive their health insurance from their employer . This includes both private insurance through the employer and public insurance programs like Medicare and Medicaid . However, lower-income households are less likely to have employer-based coverage .
The patient and healthcare professional experience has deteriorated, and employers are facing increasing insurance costs.
Consequently, like innovation, Sick Care, USA is underserving every American, just unevenly doing it. Everyone has to confront the social determinants of heath, to some degree or another, despite their socioeconomic class or demographic profile.
Programs that target the needs of specific underserved communities at best are treating the systemic symptoms, not the disease and at worst treating the disease but not recognizing the manifestations of the siloed, sick, sick care system of systems syndrome.
In doing so, they are exacerbating the already contentious environment of shirts v skins including doctors v patients.
Arlen Meyers, MD, MBA is the President and CEO of the Society of Physician Entrepreneurs on Substack