Real Health Reform Not on the Menu

Providing private and public health insurance to more people is a pale imitation of the kind of health reforms Americans need. Yet it is the focus of nearly all discussions in Washington about how to change the nation’s health care system. The rest of Capitol Hill’s bandwidth is devoted to rolling the price-cut rock for drugs up the hill and watching it roll down again and again.

Outside the Beltway, health experts and researchers have been begging policymakers to pay serious attention to glaring health shortcomings. Research studies this past week emphasized some of them. My health care book tries to pound away at them as well.

Primary Care

Despite all the wonder drugs, digital monitoring tools, and other “smart” health tech, a continuing relationship with a primary care physician remains the single most healthful behavior that Americans should pursue. Research shows that such continuing care literally extends life spans.

“High-quality primary care is the foundation of a robust healthcare system, and perhaps more importantly, it is the essential element for improving the health of the U.S. population,” according to a report from the National Academies of Sciences, Engineering and Medicine. “Yet, in large part because of chronic underinvestment, primary care in the United States is slowly dying.”

The fixes are easy to list but not to make: loosen the American Medical Association’s chokehold on medical school slots for new doctors, change the financial compensation system that places primary doctors at or near the bottom of physician pay scales, and support promising new models of primary care that product better health outcomes for less money.

The Research:
Implementing High-Quality Primary Care

Unneeded Care

As much of 30 percent of the health care Americans receive is unneeded. With annual health spending of $3.8 trillion in 2019, that’s a lot of meatballs, so to speak. But which is the 30 percent we don’t need, and how do we push back against the recommendations of our doctors, hospitals, and other medical experts whose recommendations we’ve been conditioned to passively accept, if not enthusiastically welcome?

We need enlightened practitioners to help us, plus more government focus on the worrisome rise of vertical integration among hospitals, doctors, and other providers. Study after study shows us that medical practices controlled by hospitals and private investors regard their bottom lines as their most important patients. They simultaneously raise prices and reduce the quality of care.

The Research:
Acquisitions of Hospice Agencies by Private Equity Firms and Publicly Traded Corporations
Higher Medicare Spending On Imaging And Lab Services After Primary Care Physician Group
Vertical Integration
Hospital Employment Of Physicians In Massachusetts Is Associated With Inappropriate Diagnostic Imaging
Is your hospital performing unnecessary tests and procedures?