By: Omar L Hamada
Healthcare used to be a rather simple transaction between a physician and his patient. However, with knowledge and technological advancements and the commoditization of healthcare, third parties soon realized the extraordinary amount of profit that could be made by interrupting this relationship, and shoe-horned between physicians and their patients to develop a better business model.
These same technological advancements rapidly improved medical care and helped extend the lives of many while somewhat necessitating 3rd party intervention as no individual physician could afford these devices such as CT and MRI scanners to care for their patients through larger medical groups could. This quickly morphed into increasing governmental regulations in most every aspect that protected third party interests but limited physicians’ and patients’ abilities to autonomously interact, opprobrious insurance and Medicare contracts, hospital ownership of physicians and their practices, the expansion of non-physician providers who extended care for much less expense though at a lower quality metric, a primary focus on pharmaceutical interventions with eventual direct-to-consumer advertising, and on and on. Of course, there were benefits to each of these, but in the long run, except for direct stakeholders those benefits were significantly impacted by the negative effects caused by their implementation. That impact took the form of decreasing access to healthcare for many, decreased quality in certain areas of healthcare delivery, and significantly increased costs to the consumer to the point of being prohibitive to a large percentage.
With the above in mind, the United States still had worse outcomes and spent more on health care compared to other high-income countries (i.e., Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United Kingdom.).
Though tens of trillions of dollars have been spent on healthcare over the past few decades, and despite incredible scientific discovery and innovation, access to physicians has decreased, costs of delivery have exponentially increased (due primarily to an explosion of administrators and related costs), and quality has continued to decline in some areas while it has improved in others. Though healthcare expenditures eat up close to 20% of our annual GDP, and though healthcare is always a forefront issue in political campaigns and Congressional activities, we continue to falter in each of these three core areas – Access, Cost, and Quality, as we continue to fall further and further behind the OECD countries we refer to as comparators.
What has happened is that the message of Medicine – the message of hope and healing, has been replaced by the business of healthcare except for a cursory hat-tip to quality and patient satisfaction primarily meant to increase reimbursements. With the promulgation of chronic disease management brought on by an upside-down USDA food pyramid, we’ve also seen the advancement of forced governmental mandates, increasingly complex reimbursements, expansion of non-physician providers delivering autonomous and unsupervised care, we’ve also noted an explosion of distrust, complexity, inefficiency, and hostility resulting in a nearing implosion of US healthcare. This is being quickened by fed-up consumers, low morale among providers, unsustainable costs, and an ever increasingly overbearing regulatory environment. Despite this, healthcare stocks continue to climb and pay huge dividends.
Of course, as broken as it is, there is yet great hope and opportunity for those who understand the business side while also pivoting in their perspective of what healthcare should be. In fact, even now, our healthcare system does work and despite the obstacles above, we are still able to receive some of the best medical care in the world in the management of disease.
Though most every OECD country has lower costs and better outcomes with healthcare that is almost entirely governmentally subsidized for all citizens, access is still an issue with many long delays at the point of care. As we consider healthcare delivery in these other nations, we see variations on pretty much free and subsidized healthcare for all for even noncitizens. The United States made a move towards this model in 2010 with the Affordable Care Act (ACA) by essentially laying the burden of subsidizing payment for the less fortunate on those who better off through up to tripling monthly premiums while doubling annual deductibles and heavily subsidizing hospitals to incentivize engagement. Though improving access for some, the ACA decreased it for others.
There is a new movement that is rapidly expanding as many break free of the current sluggish and overwhelmed system and re-establish the long lost direct physician-patient relationship unencumbered by third parties. However, this necessitates 3 things.
First, the approach to healthcare delivery must change. We must shift to a model that incorporates a physician-led, patient-driven collaborative relationship that utilizes truly exciting innovations proven to significantly alter the health of all who engage. With the proactive use of rapidly expanding artificial intelligence and machine learning, nanobots, biosensors, 3D printing, stem cells and exosomes, biomes, peptides, proteomics, and unique methods of early diagnosis and therapeutics, this genetically driven precision and personalized medical approach that addresses every aspect of a person’s health will radically transform individual and national healthcare for the foreseeable future. We are shifting away from a model of chronic disease management to one that encourages prevention and disease reversal through education, behavioral change, personal responsibility, and revolutionary scientific advancements.
Second, patients must take personal responsibility and must realize that the majority of their healthcare lies in their own hand. In fact, over 70% of one’s health is determined by the personal everyday decisions we make in terms of what we eat, how we sleep, and what activities we take part in. So much so that our daily habits can significantly alter genetic expression and cellular function. Patients must also break free of the mentality that their health is the responsibility of the government and realize that they will necessarily incur some personal expense for improving and maintaining their health if they want the best cutting-edged care available that enables them to increase the time they live disease-free. However, we understand that this may not be for everyone as many are either unable or are truly satisfied with what amounts to an inefficient and relatively ineffective multi-layered highly matrixed governmentally run system focused on the long-term management of chronic disease.
Third, physicians must innovate and shift their thinking from a pharmaceutically based chronic disease management style to a truly innovative scientifically-backed method focused on health. We must improve access, shift costs, and improve quality of care as we see an increase in longevity through reversing chronic disease and aging with an improvement in health span as well as an optimization of human performance in every area from brain function to cardiorespiratory endurance to musculoskeletal strength and flexibility.
The leading causes of death in America as we age are cancer, heart disease, stroke, and dementia. Not only are these all preventable, but they are also reversible. What’s coming is incredibly exciting, but it’s not just coming, it’s already here and widely available for those willing and motivated to engage.