Well, one pharmaceutical CEO gets it! I was emboldened to read David A. Ricks', CEO of Eli Lilly and Co., editorial. He points out that regardless of Apple, Amazon and other tech companies’ entry into healthcare, there remains one huge barrier: the outdated U.S. health care system.
You repeatedly hear me saying how we all made this mess – and we can all fix it.
Ricks adds to that by pointing out that the foundation of America’s health care system was designed 50 years ago to treat mostly acute episodes of illness inside brick-and-mortar facilities with lots of people, lots and lots of paper, and very little technology.
This is no longer our objective when, today, Ricks states our primary challenge is to help people live independently with mostly chronic illnesses over a long period. I would add to that our actual goal should be prevention since the majority of those chronic illnesses could be completely alleviated with a proactive wellness model instead of even continuing a “sick” model. (And how about pharmaceutical cures rather than lifetime drug regimens Mr. Ricks?)
And yet, as Ricks, points out, “We continue to pursue this task with the same high-cost, high-touch tools that were built in a different era for a different job.”
The result of this mismatch is unsustainable, skyrocketing health care spending. Thirty years from now, Alzheimer’s alone will require more Medicare and Medicaid spending than the entire 2019 U.S. military budget. We will hit a wall.
Ricks says that digital technology, when combined with pharmaceutical technology, will be crucial in reducing the massive cost of health care, yet it isn’t enough – we must have an efficient network that can unleash the power of today’s technology.
According to Ricks, we must do three things: digitize everything, empower consumers, and pay for value.
Digital technology already has an information superhighway to act as the foundation of that efficient network. An online retailer can reach people literally worldwide with just a website – compared to the few hundred thousand dollars for a brick-and-mortar store that reaches only one community.
We must develop common standards and patient privacy protections – and I would add greatly improve cyber security and enforcement – that allow data to flow through our health care system freely and safely. Medicare can also help by reimbursing at higher rates for products and services that combine digital, medical, and pharmaceutical technologies.
Ricks agrees with what I said in my book Bill Please: Consumers Driving Health Care, and what Regina Herzlinger, the mother of consumer-driven health care, stated in her book, Who Killed Health Care? America’s $2 Trillion Medical Problem – and the Consumer-Driven Cure, that in nearly every industry, consumers are the catalysts for reducing costs and improving quality. We also all agree that this hasn’t happened yet in health care – because, as I’m always stating, it is opaque and nearly impossible to get meaningful cost and quality information before receiving treatment.
Ricks uses the same example as Herzlinger and I – “When you buy a car, you don’t care what the manufacturer paid for each of the 30,000 parts in it. You care what the price of the whole is, and how well it functions, before you drive it off the lot. We need that kind of transparency in health care, to enable consumers to make more informed decisions and to encourage health care companies to meet consumers’ expectations.”
Pay for Value
Ricks and I diverge a bit here. Just as I believe we must go further than continuing a “sick” model, I believe we must go further than the value-based care model Ricks supports. We must go all the way to a well-being model. I also believe that Concierge Medicine is the payment model that makes the most sense in implementing a well-being model, with health insurers only needing to provide catastrophic insurance. Providers' greatest revenue incentive, then, is to keep their patients healthy from the get-go. This also means, of course, that medical school curriculum needs a complete overhaul to equip providers to accomplish this. Being a doctor would need to be much more than slice and dice, even though we still need them to know these skills as well – assisted by robots, of course. :o)
What if every employer contracted directly with Concierge Medicine Programs then offering their employees catastrophic health insurance as well as supplemental gap insurance?
I wholeheartedly agree with Ricks that the greatest barrier to the system we want – and deserve – is the system we have, and that, “To realize the transformative potential of the digital revolution in our health care system, we need to change [reinvent] it.”
Source: David A. Ricks, August 27, 2018 “Eli Lilly CEO: Why Consumers Are Key to Bringing Down Health Care Costs” Fortune retrieved 9-28-18 from: http://fortune.com/2018/08/27/eli-lilly-health-care-pharmaceuticals/
Well, the GOP managed to slip a repeal of the ACA's individual mandate into their new tax law. But will it topple the ACA apple cart?
I doubt it.
Because the individual mandate, designed to "require" young, healthy Americans to buy health insurance never worked. The young, healthy millennials I spoke to just did the math - 5% of their income or a minimum of $695, whichever is lower - and compared that to hundreds of dollars a month to buy insurance they may not use? They just paid the penalty. Or they didn't.
Fact is, the IRS had no real way to enforce the individual mandate. The IRS can’t bill people that didn’t buy health insurance. It can’t garnish their wages, threaten tax evasion charges or report them to the credit bureaus. All it can do is deduct the fine from their tax return. If they have the right amount withdrawn, they won't get a tax refund to deduct the penalty from.
The fear that only those who need health insurance will buy health insurance was already happening.
But let's talk about the real problem here.
An opaque, inefficient health care system with skyrocketing, unsustainable costs.
Health insurance, while not lily-white in their dealings, has nothing to do with this real problem and fretting over young, healthy people buying health insurance will not fix the real problem.
We need a transparent, accountable, affordable health care system.
As I've said before, if health insurance and the government, who are both practicing medicine without a license, stepped aside, and it was just consumers and providers, health care would get fixed in a jiffy!
Gee. How about health insurance companies and the government pitching in with a clear focus on empowering consumers, then staying out of the way!
We've still got a long way to go. I know you're weary - and so am I. But we've got to keep stating that we want consumer-driven health care - now.
Yeah, I just wrote the last post - and bam, Congress got something done - for now. A two year bipartisan deal to pay the cost sharing reduction subsidies. Don't know if it will pass through the full Congress. Trump supports it - for now. He still has his sights set on a full repeal and replace, though, tweaking the Graham-Cassidy-Heller-Johnson bill. And the saga continues... .
Meanwhile, emphasize to your public servants in Washington anything they decide to do needs to empower consumers to drive health care... .
Is anyone else having Deja Vu? It seems to me that Trump has just done what the GOP was criticizing Obama for - unilateral (and illegal?) decision making on health care, slinging that pen on those executive orders like there's no tomorrow.
I seem to recall the GOP suing the Obama Administration for cost sharing reduction subsidies without appropriation approval through Congress - and winning (which was in appeal), because that is not how our government is set up. Appropriations of our tax dollars are supposed to go through the legislative process - one of the differences between a democracy and a dictatorship.
Trump's announcement last Friday that he has signed an executive order to not pay those cost sharing reduction subsidies to insurers, stating his administration is heeding the advice of the Justice Department, may stick, even in light of the lawsuits that are racking up. There is the sticky point that the insurers were promised those payments by a former administration, and changing horses in the middle of the stream may still end up in legal quick sand, but there also is a legal standing.
Now Trump's other health care related executive orders - selling insurance across state lines and the right to purchase health care plans through formed associations, with some other items added in - the jury is still out.
What can you do? I sound like a broken record, I know - but we deserve transparent, affordable, accessible, high quality health care in America, and until we are dealing with those issues, we won't get it. Tell your public servants in Washington that we need consumer-driven health care.
I realize I'm in health insurance, but just imagine what would happen if there were no more health insurance and no more employer health care benefits and no government practicing medicine without a license. Wham! It's all gone. What would happen? We would immediately have affordable health care because it would be back to the providers and the patients - us. Providers, pharmaceuticals, and everyone else in the health care industry could no longer hide behind insurers or employers or the government - they would immediately have to figure out how to provide us with their services at prices we could afford.
Now, I realize health insurance serves an important purpose, but you see my point. Maybe I, health insurance, the government, and employee health benefits need to take a year-long vacation. When we come back, rested and refreshed, bet you the health care industry has figured out how to do or die. Bet you consumers then have the transparency and the quality competitive choices they need to shop effectively for the health care that is right for them.
I repeat - tell your public servants in Washington that we need consumer-driven health care - everyone except doctors need to stop practicing medicine without a license - and they need to put their eye on the right ball - health care transparency, affordability, accessibility, and quality.
Oh, and there's no room for loner cowboys. This is a democracy, for the people and by the people. We want our democratic system honored, respected, and intact. We elected all of you - not just one of you. Stop acting like Washington is a sandbox. Grow up and get 'er done - together.
If the GOP wishes to repeal and replace the ACA with just their majority under the rules of the Reconciliation Act - their time is quickly running out. On September 30th that option expires.
GOP Senators Graham (R-SC), Cassidy (R-LA) and Heller (R-NV) are the main sponsors of what looks to be the GOP's last hope, which pushes block grants and health care decision-making to the states. See a major point comparison with their bill and the ACA here.
Don't forget to contact your representatives and let them know, as a consumer, you want control to achieve transparency, accountability and affordability in America's health care once and for all.
Shortly after John McCain decided the fate of the GOP Senator's last health care bill intended to repeal and replace the ACA with his thumbs down a month ago today, GOP senators Lindsey Graham (R-SC), Bill Cassidy (R-LA) and Dean Heller (R-NV) were in Trump's office sketching the outline of yet another try. Running any attempts through the Reconciliation Act, which would only require GOP votes, is a moving window. We'll see how it goes... .
Meanwhile, consumers need to continue to contact their representatives and tell them that only consumer-driven health care can achieve the transparent, accountable, affordable health care we deserve.
Read the latest version of the Senate Health Care Bill below - and the saga continues - meanwhile, let your representatives know only consumers driving health care will transform our U.S. health care system into what we all need and deserve.
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