Jamie Dimon, Warren Buffet and Jeff Bezos want to reform healthcare; other than cost, do they understand the problem?
The NY Times announced that Amazon, Berkshire Hathaway and JPMorgan Team Up to Try to Disrupt Health Care. This has been echoed over numerous news outlets over the past couple of days. While I can understand that big business has an incentive to do a better job than insurance companies, do they understand the problem? I wish Dimon, Warren Buffet and Jeff Bezos good luck.
Insurance carriers in the USA have a long history of modifying the way doctors practice, yet each time they changed the paradigm, doctors and the systems they work in managed to find workaround’ s to take advantage of the new rules and as a result, everyone has paid more.
To fix a problem, you need to understand what the problem is. Healthcare in the USA just costs too much, doctors charge too much, hospital billing systems just bill to much and nobody without insurance can get a straight answer to why we need so many people to help us solve our health problems. As many of us know, if you go to a hospital, you will get a bunch of bills from people you never met, from billing companies you do not know.
The problems are many including lifestyle, sugar in our diets, not enough exercise, disease care, the cost of a doctors education, how doctors are educated, the profiteering in the medical device field, the profiteering in the drug companies, a lack of price transparencies, high deductibles, and tiered plans. This does not include the fact that primary care doctors are underpaid, overburdened, and are forced to see too many patients to pay their overheads. Hospitals and large doctor groups now have more clout and command higher prices. I could go on but this is what is wrong. Insurers have access to lower-cost higher-quality providers such as chiropractors and naturopaths but rarely insure them properly, forcing patients to visit higher-cost providers regardless of the cost. Rather than identifying the problems behind the problem, they manage the problems with drugs and call our problems diseases, while passing us around from doctor to doctor, with their science-based, but not necessarily scientific approach to healthcare management.
Obamacare attempted to improve our choices, while requiring we also continue to use private insurers who had an incentive to make insurance more expensive due to the 80/20 rule which basically says that insurers can only keep up to 20 percent of your premium to run their businesses and the rest must be paid out in claims. Insurers needed to make healthcare rise to increase their profits which are at an all-time high.
What should a new healthcare insurer by three smart business leaders look like?
It is simple; skim off all the profiteers, reduce copayments to everyone who wants care can get it, reduce the use of third party administrators who just add a layer of cost and difficulty for healthcare providers, and expand primary care to include nurse practitioners, chiropractors for musculoskeletal evaluation and reduce incentives for procedures such as doing surgery. You will also need to simplify the path and reduce the cost of becoming a doctor, which is one of the reasons salaries need to be high.
Existing systems will play hardball. The large institutions will insist that we need to have multiple specialists for everything but do we really or is this part of the problem. The drug companies will insist they will need more drugs for diseases, it will be a nightmare.
They must also get involved with the educational systems that teach most healthcare providers that everything is a disease and work toward a wellness model that uses fewer drugs. If we want capitalism to reduce the cost of drugs, we must reduce demand.
Chiropractors have the best record for back and neck pain and are the best-trained providers for conservative musculoskeletal conditions and are the least likely profession to recommend medications.
A new system must improve access and primary care must be able to spend the time necessary to get the job done right and be paid for it. Micromanagement of healthcare must become a thing of the past; it does not work and simply drives costs.
Preventative care must not only look at bloodwork, pulse, and heart rate, it must also become more holistic and look at the human frame. Primary care must become more holistic and musculoskeletal problems must see a chiropractor first for proper evaluation of mechanical problems. Doctors must look to find the commonality for the symptoms we experience, and move away from treating and evaluating every symptom. Resolve the problem, a series of symptoms are likely to improve and the patient will be much healthier.
Healthcare systems are moving toward population health which is a factor approach to the masses. We are not widgets and must have individualized approaches in these systems to help us as we age.
Changing these systems will not be easy. Nor will it be easy to force systems entrenched in these practices to change and improve their efficiencies. They will want to maintain their business models. Systems much become simpler and diagnostic testing must be used more appropriately and priced more appropriately as well.
I wish them luck in their new idea. Maybe they will be a chance to see these ideas. Not a bad framework to start with. Better access, lower cost, and a better system is achievable but our healthcare business processes must change and they must use lower-cost high-quality providers to take the preverbal air out of the systems tries to get them to change.
As a chiropractor, how can I enlist in this new endeavor?