I would not even attempt to appear to understand lawyer speak and speculate on what our esteemed supreme court justices would rule on by end of day tomorrow. This article is not about predicting what the justices will say, rather it is about what the impact is going to be if they vote against the “individual mandate”. Did the federal government build the case in such a way that even if the individual mandate gets struck down, will the rest of the Affordable Care Act move forward? Ignoring the political ramifications o f the ACA left intact or rolled partially back, we as a country have a problem to solve.
With a combined spend of $2.7 trillion per year in the USA on healthcare, the outcome of the ruling is important for all of us. We as citizens will eventually need to pay for the bill one way or the other.Some interesting statistics make this more relevant – Chile a small country, a fraction of the spend of USA has a better infant mortality rate than the US. In other words a child born in Chile has a better chance of surviving than a child born in the USA. Another metric to keep in mind – 49% of the healthcare spend in USA is accounted for by 5% of the 311 Million US citizens.When you look at the diseases that cost the most to treat, they are lifestyle diseases to an extent – Mood disorders, Diabetes, Heart disease, Asthma and Hypertension. Of the top-spending 25 percent of Medicare beneficiaries about 42 percent had coronary artery disease, 30 percent had congestive heart failure, and 30 percent had diabetes. Each of these is very expensive to manage let alone cure.
What do all those statistics mean ? Bottom line is that we need to treat people with these kinds of conditions very early in their life. We need to intervene at the right time to influence care. We need break the cost curve by getting people healthy. We need to encourage people to stay healthy by living right. Lack of insurance coverage influences the ability to do all those. It prevents the system from being able to provide care at the right time. When interventions are prevented, diseases continue to grow, chronic conditions continue to expand and eventually co-morbidities start to form – with only one outcome – a more expensive intervention later in the life of the patient. As the CEO of Kaiser Permanente, George Halvorson wrote in his seminal book – a perfect system focuses on the patient. It is not built around revenue streams, it is not built around care givers and it is not built around cost models. Healthcare reform should not be about a comparison to “will the government next tell me to eat broccoli”. It certainly is not that – it is about the cost of health care and the price we are paying. When healthcare costs 17% of the GDP and is forecasted to grow exponentially more, we have to pay attention as a country. In other words for every dollar of net goods value created in the country we are using 17c of that to fund Healthcare. In a recent study published in the American Journal of Medicine stated that 62% of personal bankruptcies filed in 2007 were due to medical expenses. In an economy that is in doldrums for an extended period of time, a huge swath of the population is one disease away from a bankruptcy. Is this the state we want this country to be in?
When 16% of the US population is uninsured, that particular population has a higher probability to use more expensive services after the onset of disease rather than being able to take advantage of preventive care which is cheaper earlier in their life. With fewer employers providing healthcare, government funded programs like Medicare, Medicaid have had to pick up the slack. In an imperfect system as George Halvarson writes, “People stumble into the Emergency Rooms”. This is the most expensive intervention that could happen. At this point there is no real chance to prevent. The whole equation has now changed to no options other than one – expensive care in a setting that is the most uncomfortable for the patient.
Analyses of health care spending patterns shed important light on how best to focus efforts to help restrain rising health care costs. Recognition that a small group of individuals account for a large fraction of the spend serves to inform more focused cost containment strategies.
So for a moment forget the politics of the country, put aside the bickering in Washington, extract yourself from the noise on various facets of the ACA – and focus on the economics of the problem – there is only one answer that comes to mind. Design, build and drive a system that provides a safety net that ensure early and effective interventions, that motivates people to live healthier life styles that enables a more equitable distribution of cost of health care. At the end the goal should be to improve the health of the country at an affordable price point.
In conclusion – lets focus on doing what is right – improving the health of us as citizens.