US healthcare: A Bureaucratic Quagmire Needing Disruption

The US remains one of the most innovative if not the most innovative hubs for cutting-edge inter-disciplinary research spanning medicine, bio-medical engineering, genetics, and drug discovery with AI accelerating these innovations at lightning speed. And yet, US consumers experience some of the least satisfying outcomes in healthcare while spending more than any other nation on the earth. US consumers wait longer for appointments, spend more time in hospitals, and worse, the US remains one of the most inequitable healthcare systems in the world.

It isn't that these problems are not well understood by policymakers, executives, and consumers. These statistics are being shouted from every roof-top by every contesting lawmaker. Laws get made; new start-ups appear frequently with the promise to improve care; VCs glowingly talk of how their investments are bridging gaps in equity and reducing the costs – but if any, these changes have been minimal and marginal. Some of the biggest corporate names individually and collectively have tried and have bitten the dust. What we continue to experience are mergers and consolidations with no palpable impact – life or economic - on the end consumers.

How is this possible, one may ask? Is this such a difficult proposition? At a time when legacy industries like transportation and energy are getting disrupted, what impediments prevent disruptions in healthcare?

The answer lies in the way the industry has evolved into an obfuscating network of institutions with competing interests and skewed incentives driven by time-warped bureaucratic regulations and laws.

For beginners, the system?has ZERO incentives for healthy living and life (misaligned incentives). Secondly, the most important stakeholders of health – the patient and provider have the least say in what and how they should be treated (lack of end-user satisfaction). Third, the system works in a reactive mode to treat an episode of sickness with little incentive to look for holistic signs of distress (cost). Finally, it works on a one-size-fits-all intervention (lack of engagement) defined by payers and bureaucrats with little scope for personalization at a time when the prevailing medical and clinical evidence calls for more personalized diagnosis and interventions considering an individual’s social determinants and family history.

These fault lines get magnified even further when you examine them against the economic, demographic, and geographic scale of the US vis-à-vis the rest of the developed world that dwarfs in front of the US for scale and complexity. Thus, the US simply can’t follow or resort to national payment models or universal health coverage paid for by the Governments. Instead, the collective effort should be to offer universal health coverage but its implementation should be driven by a set of guiding principles that encourage and incentivize healthy lifestyle; early detection and intervention; triaging the delivery to ensure the neediest of the care get it first and fast; more efficient allocation of resources; making care centers nimbler and smaller; not stifle research and innovation under the guile of privacy (instead encourage seamless sharing and dissemination of data while protecting anonymity).

It is also imperative that the change must be radical disruption of the system and not taping and bandaging to prevent a few leaks. Like how climate change has come to the forefront of both legislative and enterprise agendas seeking more practical and urgent answers, US healthcare too is a massive catastrophic fault line that needs our immediate attention. We can ignore it at our own and our posterity’s peril.

Through this series of blogs (links at end of the article), we aim to explore each issue mentioned above in-depth and present our proposed solutions in the concluding parts of this series. Stay Connected. Stay Curious. Thank you for your attention!

Authors: Dr. Errol Norwitz and Venkata N. Peri.

Links to the complete series of Blog - US healthcare: A bureaucratic quagmire needing disruption :

The problem: Misaligned incentives: Published on 25th March 2024

The problem: Cost: Published on 1st April 2024

The problem: Lack of engagement: Published on 8th April 2024

The problem: Tracking?the satisfaction of the end-user, the patient: Published on 15th April 2024

The solution: Innovation in healthcare: Published on 29th April 2024

The solution: Is AI a threat or a solution? Published on 8th May 2024