U.S. Health Care Gone Wrong- A Pictorial Guide Part Four: How Do We Fix This?

This is a fourth and final part of a four part series looking at a pictorial guide to health care in the U.S.

I'm a practicing physician in Reno, Nevada and have been doing so for 30 years. I've worked in 3 different health systems I've been a part of U.S. Health Care for the past 15 years and watched healthcare change from the pinnacle of success for a developed nation to becoming a murky, expensive a fight amongst corporate entities for more dollars. Where did we go wrong? Let’s see if we can unravel how we went from nightingale floors and charge nurses with clipboards who rounded with physicians to EMRs, denials of care and bloated co-pays.

 This is the final Part Four of a Four Part series looking at American Health Care. Part One looked at defining the problem; the problem in a nutshell is we pay too much and get too little. Part Two, looked at who the players are. Part Three showed how they do it. In this final part, Part Four, I will offer potential solutions.

The following is a clickable guide to show this graphically so you can see the source of the chart or graphic.

In Part One we saw how much more expensive health care is in the US and how we don’t necessarily get what we pay for.

 In Part Two we looked at who the players are who drive up costs in the U.S., mainly drug companies, payers and large hospitals.

 In Part Three we looked at how payers, drug companies and hospital tactics to protect their bottom lines pushes up health care costs.

 In this final part, Part Four, we will look at potential solutions.

Below are just talking points, not as many pictures or links as the other parts. Again, I’ve worked in 3 different health systems and saw the good and bad of each. Below is what I think would work and does work in other systems. The biggest complaint of systems like Canada is access. Systems with a public and private sector, like Australia, address access.

1.    Look at other health systems

Not Canada but Australia. Insurance for all but you can buy additional private health insurance not tied to your job and not bloated and expensive. A two tier system does not need to break the bank. The current focus on the pros and cons of a single payer system misses the point that the system as it is, is too expensive.

2. Transparency

At every level. Hospital charges, insurer charges, physician charges, approvals, with no surprise bills. This is a big one. Mystery is a margin. Hospitals, PBMs and payers do not want this and don't want us to see what they charge and what things cost.

3.    Emasculate big pharma.

Use market size to bargain down drug prices. Get rid of PBMs. Get away from orphan drug protection (see Part 3). Make sure when patents expire that drug companies cannot 'evergreen' them. Make the generic market stronger. Look at how pharma is dealt with in other countries.

Don't let them raise prices of drugs indiscriminately:

4. The Government, like the VA system has to negotiate drug prices.

5.    Health care need to be a free market.

"In a free market, goods and services are allocated through transactions based on mutual consent. No one is forced to buy from a particular supplier. No one is forced to engage in any transaction at all. In a free market, no transactions occur if a price cannot be agreed. The medical industry exists almost entirely to serve people who have been rendered incapable of representing their own interests in an adversarial transaction. When I need health services I often need them in a way that is quite different from my desire for a good quality television or a fine automobile. As I lie unconscious under a bus, I am in no position to shop for the best provider of ambulance services at the most reasonable price. All personal volition is lost. Whatever happens next, it will not be a market transaction."

6.    Pay nurses (and teachers) well.

Frontline workers provide the day-to-day care. We can’t lose them. Stop exploiting them.

7.     Make private health insurance companies put their profits back into the system to reducing premiums.

There is a hypocrisy in premiums rising but profits for the payers also rising.

8.    Standardize pre-approvals and prior authorizations

The bureaucracy is dismantled. Offices will need less staff. This will reduce payer profits but they will need less administrative personnel

9.    Reduce the number of hospital administrators.

10. Give the health system back to doctors:

11.    Make Not-For-Profit hospitals more accountable for providing care to the community.

If health care for all is available, hospitals need to show transparent and open about reinvestment in the local communities in order to obtain tax credits. The gains should be balanced by forgiving bills on those who cannot afford them and charity.

12. Put people who have actually looked after patients back in charge.

Compassion and empathy are lost by those who have never worked on the front line, worked a night shift in a hospital.

13. Limit and control vertical and horizontal integration

Stop monopolies on the supply chain and potential collusion

14. As consumers, shop around.

Blue book surgery costs just like buying a car:

15. Avoid hospital facility fees if you can for procedures like MR scans.

Shop around for the cheapest rates.

16. Cap medical bills and legislate against surprise bills.

Look at ways to avoid them in the interim:

17. Complain to State Insurance Commissions for unjust denials and charges

Here are the links for Nevada and California but you can find your state easily enough:

Nevada: https://doi.nv.gov/Consumers/File-A-Complaint/

California: https://www.insurance.ca.gov/01-consumers/101-help/

18. Keep asking questions

19. Vote with our feet in every way:

where we get our pills, x-rays and services, which hospital we have our surgeries, which payer we align with.

All of the suggestions above that cut into corporate profits of payers, drug companies and hospitals. These stakeholders have the best lobbyists and the deepest pockets and will fight change as they have the most to lose. It's not about 'single payer'. It's about reducing the cost of health care in the U.S., making it transparent and a free market letting supply and demand dictate price. There lies the rub. Nothing will change wild the big three pharma, hospitals and payers keep using middle America as an ATM and we keep tolerating the bleeding.

We need to get to word out. Things have to change.