Our health care system is broken. It is nearly impossible to argue against that fact considering our nation spends more money than any other nation on health care, yet we have significantly shorter expected lifespans than other nations. So, the debate on health care policy reform does not come down to whether or not our system is broken, rather why that is the case and how we can fix it. Tom Scully, former Director, Centers for Medicare and Medicaid Services under George W. Bush, offers a compelling argument for why the economics and outcome in health care is the case. Scully told Washington Center students that the reason this phenomenon occurs is that of the high costs of hospitals and lack of utilization of preventative health and primary care physicians. This made me reflect moving forward that future health care efforts, particularly public health, need to focus more on increasing medical literacy and push health care rhetoric to focus on prevention rather than “sick Care” and hospitalization.
A New York Times article reported on a study conducted to determine why there are such high costs of health care, yet low health outcomes are still occurring in the United States in comparison to other nations. It found that “we pay substantially higher prices for medical services, including hospitalization, doctors’ visits, and prescription drugs.” This is almost entirely due to administrative costs that accumulate in the hospital. The article also noted that the problem is not necessarily only that we are paying more for all these things, but that we need to cut back generally on hospital visits and utilize other resources that are lower in cost and available in the health care system (preventative care, primary care, and long term care facilities). Most important to note is that the article mentioned that the United States has higher levels of poverty and obesity than other nations, which is something that cannot be explained or fixed by utilizing different healthcare delivery or insurance systems (Sanger-katz, 2018).
Putting together the information and claims made by the New York Times article and the opinions and analysis presented by Tom Scully, the problem with our healthcare system goes much deeper than just insurance coverage. It is truly rooted in social barriers to ideal access to health care and the minds of Americans in general, and this is something that different methods of health insurance coverage can necessarily fix. In this analysis, I will only consider the minds of Americans, like diving into the social determinants of health would take pages upon pages. The problem really comes down to the fact that Americans are not properly educated in medical literacy. The health care system is a very confusing institution and, especially for the elderly, it can be very difficult to understand why and how to make basic decisions about health care coverage. For instance, someone might not truly understand how much more simple and beneficial it is to go to Urgent Care or a Primary Care Physician for a sore throat if that is covered at a higher level than visiting the emergency room. Essentially, Americans do not always understand that they can “shop around” for medical coverage or treatment based on what might be covered greater by their particular insurance. This would save both the patient money as well as the hospital potentially money in high administrative costs. That is why then, health care policy reform truly needs to put a better focus on actually educating the public about what decisions to make when trying to navigate the health care system.
Another important aspect of changing the way Americans think about health care is pushing towards preventative health care. Every year, more and more Americans die from chronic illnesses, such as coronary heart diseases or Type II diabetes, that can be almost completely preventable with certain lifestyle changes. Finding a way that our health care system could incentivize Americans to follow healthy diets and engage in simple but beneficial exercise would truly cut significant costs in the health care system.
These ideas and changes to the foundations of the health care system may seem a little abstract, but as Senator Bernie Sanders mentioned to Drake University students, “the problem is the limits of our imagination.” So, changing the minds of Americans and our health care system in general to better value preventative care and utilization of primary care over hospitalization could provide a more efficient and less controversial, when it comes to partisanship, health care reform to cut spending on administrative costs and care for chronic illnesses, so that this money can be utilized in other aspects of the health care system.