Getting Rid of Excess: Fixing America's Healthcare System

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I think the biggest single challenge we have in American healthcare is that the average American family cannot afford the average premium. You think about that for eight nanoseconds, that's a wee bit of a problem. The average French family can afford the average premium because it costs half as much.

We're beginning to recognize that more is not better and we're actually creating some financial incentives to reward reductions and readmission, reductions that harm and I strongly applaud that, I think that's a really good direction for us to send signals to the health care delivery systems, the excess, usually excess that does harm is a bad thing not a good thing and that's an important step [xx] and I think we got to move the systems towards rewarding health not rewarding procedures.

And it's easy to say, but it requires a massive change in the way we train people, how we deploy people, how we [xx] patience and providers to do, what they do. The other point I make to people when they say, well obviously this is going to cause a shortage of doctors and blah, blah, blah is, look that's only presuming we keep doing things exactly the same way right.

So change the way we do what we do and I think if you look at sort of innovative care delivery models where people are confronting this challenge head on and saying look, we're going to have more people with insurance cards, what did they do when they have an insurance card? They turn up right and they turn up for service.

So we have got to find a way that deliver more services by realigning and redesigning our care delivery models. I'm actually quite encouraged people are taking on that challenge in a creative ways and I think it's goes back to the believe structure within medicine that if you are well trained, if you went to Johns Hopkins and you were trained by the best in the business and your mentor was the best in the business and you learn everything from your mentor and you are well intentioned, then obviously whatever you do is of high quality and if you commit your life to continuous learning and reading the journals then why won't what you do be the best? And I think that served us well for may be a 100 years but I think we're now in a situation where the amount of information that's cascading out of the science enterprise is so massive that no human could possibly carry that stuff in their head, I think compared to the 90's I think we've made enormous strides in measuring quality.

We're not perfect and we certainly haven't yet got to what I think is the Holy Grail of quality which is measuring outcomes, true outcomes of care. I would say it's much more similar to global warming, it's insidious because you're not going to get killed by global warming tomorrow, but some would argue, scientist in that field would argue we kind of left it too late and I worry a little bit about with health care, that's a little too late.