photo by lindaaslund
Someone Must Pay for Health Reform is the title of an article by Catherine Arnst in Business Week (June 1, 2009). She says that, “there are only three ways to pay for universal coverage: Raise taxes, cut payments to medical providers, or ration care.” How can it be in this era of systems thinking that such a view can prevail?
It assumes that the current US view of healthcare delivery is about health, when it is actually about sickness. The whole current argument rages around a sick system that is not focused on wellness. The systems view would require a zero based discussion around the human condition and the elements that cause and affect it.
Altering the payment structure of the way current services are delivered will cure nothing. As with many solutions that come out of a holistic perspective, chances are high that a radical review of the present (complete) system would yield far greater savings as well as a healthier society by many measures.
The evaluation of the cost of current US expenditure on healthcare is not based on outcomes, If it were the picture would look very different. We would then be able to start from a very different place that would almost certainly lead us to very different conclusions than those currently on the table.
Imagine a national wellness policy. The delivery systems would be different. Behaviors would have to change in all parts of the system – patients and non-patients, hospitals and care facilities, big pharma, doctors… In other words we would all have to take responsibility for our part. The lopsided focus on budget is not going to radically affect the system, but will simply move pieces around.
The results we want are better health (outcomes), not better finance (inputs). Otherwise total expenditures on health are going to go on rising unsustainably and we will not be better off.
One example concerns aging – a multi-billion expenditure, growing as life-expectancy increases. The focus on treatments (and huge drug R&D costs) for age-related illnesses (such as Type II Diabetes, or Alzheimer’s Disease) is not the most effective way to face either the social or economic costs. The onset of symptoms can be delayed and their severity reduced by early diagnosis of chronic inflammation and behavioral changes where it is detected. Billions of dollars can be saved at very low cost.