Policymakers from both parties call America’s healthcare system broken. By all metrics they are right: our nation has worse health outcomes than many other economically advanced countries that spend a lot less. But it wasn’t always this way.
The United States of America's health system was once the envy of the world not so long ago. And yet the system that flourished in the 20th century as a "sick care" model is inadequate to actually treat the chronic conditions patients face.
To understand why, we must acknowledge that our system was designed to face health threats that we have largely accounted for. American healthcare systems can respond to acute care needs and traumatic events effectively – but chronic disease, which affects over 204 million Americans, is a completely different story.
Healthcare professionals, lawmakers, and philanthropists must deploy new strategies and innovate new technologies to tackle the chronic disease epidemic. Put simply – we need a creative explosion for health systems nationwide. Here is a plan to lay the charges and detonate the fuse.
The reality of American healthcare in the 21st century is a constant game of catch-up: diagnosing and treating sickness after the fact, instead of the prevention of chronic conditions. It’s a stark contrast with American medical research, which remains the gold standard. How do these advances in R&D fail to translate to patient-facing care? We need to rework this system using the best technologies we have in the 21st century.
It starts in hospitals. Doctors, nurses, and other medical professionals are already overworked as is – but advanced technology can lighten the load. Treatment tracking, personally-tailored genetic treatments, and prevention plans have the potential to keep patients out of healthcare settings to begin with, while allowing medical workers to prioritize patients who need immediate care.
Most exciting is healthcare that can be delivered anywhere without the tethers of expensive hospital infrastructures. Healthcare on the go can translate into better health outcomes that consumers can see, measure and understand. Technologies like remote glucose monitoring for diabetes patients are having an impact already.
This democratization of healthcare, irrespective of location and technology, will come with prices we can all afford to pay. Those lower prices help achieve the goal to enable prediction and prevention as the primary strategy to ensure wellness, not diagnose and treat to cure sickness.
We have seen what happens when the antiquated sick care model is misapplied to chronic disease: worse outcomes for patients and doctors, though it manages to keep the billing departments and accountants busy. But history has proven again and again that innovation makes medical care faster, better, and cheaper, not profit incentives. Yet in the last two decades, despite impressive advances in drug and device technology, innovation in American chronic disease care delivery is slower, stagnant in quality, and a lot more expensive.
Take heart disease – studies show that U.S. life expectancy is stagnating in recent years due to the prevalence of heart disease instead of other drivers like drug overdoses. Yet spending remains in the hundreds of billions of dollars to treat heart disease. While we treat emergency events like heart attacks well, health systems are lost when it comes to managing the long-term care of chronic heart disease, and costs skyrocket as a result.
That last point is often the most significant problem. Ballooning costs of care represent an intolerable burden on low and middle-income workers who frequently spend as much as 30%+ of their income on medical care. It eclipses most other spending categories, as a projection from the American Enterprise Institute projects medical needs as one of the top drivers of U.S. household spending.
But we need to think in the long term. Healthcare systems strive for three goals for medical care: high quality, wide availability, and affordability. At the outset, all three combined are unobtainable – you can have only two of these attributes.
When rebuilding our healthcare system for the modern era, policymakers should focus on the first two goals: availability and quality. With a robust health care system anchored by these goals in tandem with modern technology, America will spend much less sick care and costs will decrease over time.
Ultimately, the best way to control sick care costs is by keeping people healthy. Investing in the technologies, tools and transitions required to realize that promise is the best way to do just that. HHS Secretary Kennedy and CMS Commissioner Dr. Oz are both focusing on chronic disease, value and wellness. Let’s hope these ideas can be a road map for all.
Peter Pronovost, MD, PhD is the Chief quality and clinical transformation officer of University Hospitals Cleveland. Andrew Thompson is a Silicon Valley based health and life sciences entrepreneur and investor with a 30-year track record of successful technology-based innovation.
