Is sick care USA going in the wrong direction?

Americans are concerned about the direction of the country.

So are voters in other countries. Antiestablishment populism is on the rise in Europe, fueled not just by migration and economic and security fears, but by a deeper trend: Eroding confidence in governments’ ability to overcome those challenges. The rise of authoritarian regimes is the consequence of the discontent.

A new Wall Street Journal survey found that while a majority of voters continue to hold negative views about the direction of the country and the economy, there has been a slight uptick in optimism. Nearly 30% of respondents said the country is headed in the right direction, a 9-point jump from early July, while 61% said the country is headed in the wrong direction, a 9-point decrease. The figures reflect the most favorable view of the country’s trajectory since at least November 2021.

What about Sick care, USA, Inc?

According to a new poll from Gallup, Americans' satisfaction with the healthcare system has declined significantly since 2010, with fewer people saying certain healthcare providers offered excellent or good care.?

Many doctors and nurses feel like the walls are collapsing around them and they are jumping ship.

Primary care is in crisis. In 2023, the inaugural Primary Care Scorecard made clear the systemic lack of support for primary care in the United States, which is harming people’s health and weakening the US health system. It is no surprise that one year later, in the absence of a coordinated effort among policy leaders, we see news stories on the diminishing availability of primary care physicians and long wait times for primary care visits.3 Headlines such as “Primary Care Saves Lives. Here’s Why It’s Failing Americans” and “The?Shrinking Number of Primary Care Physicians Is Reaching a Tipping Point” dominate the lay media’s reporting on primary care. Despite the overwhelming evidence that access to primary care improves population health, reduces health disparities, and saves health care dollars, support for primary care continues to dwindle. As a result, the average life expectancy in the United States continues to stagnate, and health disparities in preventive services and other basic primary care services persist, accounting for 60,000 excess deaths each year.

Hospitals, both urban and rural, continue to close.

Will we see a turnaround? Consider:

1. The emerging impact of physician innovation and entrepreneurship
2. Persistently high numbers of applicants to medical school
3. Generational attitudes
4. The ongoing policy war about US health system reform
5. The quality of care and health outcomes have shown progress, but still lag in certain sectors.
6. The overall number of Americans without health insurance dropped by 8.2 million from 2019 to 2023. These findings are included in a new report by the CDC’s National Center for Health Statistics (NCHS). The findings are featured in the report, “Health Insurance Coverage: Early Release of Estimates from the National Health Interview Survey, 2023.” It shows that among working-age Americans (those ages 18–64), 10.9% did not have health insurance in 2023, a decrease from 14.7% in 2019.
7. Health spending in the U.S. increased by 4.1% in 2022 to $4.5 trillion or $13,493 per capita. This growth rate is comparable to pre-pandemic rates (4.1% in 2019). Although government spending to manage the pandemic led to substantial increases in NHE, these expenditures significantly declined in 2021 while utilization of medical goods and services rebounded. By 2022, top-level patterns in health spending more closely reached that of the pre-pandemic period.

8. Physician burnout has been a long-standing issue in the medical community. After skyrocketing to a record-high 62.8% in 2021, exclusive survey data from the AMA show doctor burnout has fallen below 50% for the first time since 2020.

9. “Health care consolidation impacts every aspect of the health care system,” said seminar moderator and LDI Director of Policy David Grande, MD, MPA. “It’s not a new trend but it has rapidly accelerated. There were 1,887 hospital mergers announced between 1998 through the end of 2021, according to the American Hospital Association. Those mergers reduced the number of hospitals from about 8,000 down to around just over 6,000.”

10. According to the study, three quarters of all physicians (74%) now are employed by a hospital, health system or a corporate entity. The study notes that 52.1% of physicians now are employed by a hospital or health system, with the number of hospital/health system employed physicians growing by 11% from July 2020 to January 2022. This presumably includes physicians employed directly by hospitals and health systems and those employed by hospital and health system-owned medical groups, the number of which is increasing. According to the study, the number of hospital-owned physician practices grew by 8% during the study period. UnitedHealth Group has about 90,000 employed or affiliated doctors, approximately 10% of all physicians in the U.S.

11. The promise of technology to sooth our ills

12. The impact of potentially addressing social determinants of health and behavioral health disorders

In 2023, the US military spent approximately $820.3 billion, or roughly 13.3% of the entire federal budget for that fiscal year. Between private insurance, Medicare, Medicaid, and personal out-of-pocket costs, America spent $3.7 trillion on personal healthcare in 2022, according to the Centers for Medicare and Medicaid Services (CMS). Personal healthcare expenditures come from various sources including private insurance, Medicare, Medicaid, and personal out-of-pocket costs.

While issues of health care costs and affordability may not be at the forefront of this year’s election, they remain a major concern among the public. Health spending in the United States is projected to grow by 5% between 2023 and 2024, to a total of $4.9 trillion. Here are key health costs and affordability policy issues and trends to watch in 2024.

Sick care USA is the biggest American business. Here are 7 Keys To Leading Business Turnarounds And Culture Change

The sextuple aim results are mixed. The US Sick Care Machine continues its relentless quotidian march.

Its transformation to a more just, higher performing healthcare system is a wicked problem that will require reconciling the divergent interests of multiple stakeholders advocating for or against meaningful change in examining rooms, Congressional hearing rooms, campaign finance bank accounts, and the ballot box.

Arlen Meyers, MD, MBA is the President and CEO of the Society of Physician Entrepreneurs on Substack