The Pandemic in Healthcare: Ignorance

At the beginning of last week, media coverage focused on the Orlando massacre of 49 in the Pulse nightclub shooting. By the end, it had shifted to Thursday’s surprise Brexit vote to separate Britain from the other 27 European Union countries and speculation about its impact on economies in across the globe. Big stories deserving much attention.

Lost between these two were the one day stories in our industry…

  • The Medicare Trustees announced that the hospital trust fund would be insolvent by 2028, which means hospitals will get only 87% of what Medicare owes thereafter.
  • The Medicare Fraud Task Force released its 2016 results, announcing a record recovery of $910 million in a record 301 cases (vs. $712 million in 243 cases in 2015).
  • The Republicans released their substitute for the Affordable Care Act featuring suspension of the individual and employer mandates in favor of tax credits and limits on insurance benefit deductions by employers.
  • A California state official notified the Department of Justice it did not favor the takeover of Cigna by fearing premium spikes for consumers and six U.S. Senators who chimed in at the end of the week touting the potential damage from the Aetna-Cigna and Aetna mega-deals.

And there were others.

Each of these is a piece of a complicated storyline deserving in-depth unpacking to understand common themes and consequences. But for most, even in our industry, they’re one day stories that get scant attention outside healthcare.

By contrast, the daily drizzle of Clinton-Trump jabs seems unquenchable in media circles. It dominates each news cycle. I am a news junkie. Like most Americans, I hope the Orlando tragedy sparks an honest effort to address the underlying issues of easy-access to assault weapons and prejudices against the LGBT and other communities. And beyond the immediate opportunity to get better deals on travel to the UK due to the devaluation of its currency, I am uncertain about what Brexit will mean at home and abroad. But they’ll continue to be in the news, no doubt, and justifiably so.

But here’s what irks me: healthcare occupies a ubiquitous role in our economy and in our households. We are 17% of the GDP of this country, 30% of federal healthcare spending, 11% of the workforce and 14% of average household spending. We operate in every community, touch every citizen, and impact how every employer operates. But we’re understood by few. Little wonder, the rhetoric in Campaign 2016 is about other issues and one day stories like these are the most we can expect.

I read every word of articles by Pear, Abelson, Radnofsky, Wilde-Matthews and others as they cover the healthcare beat for the New York Times and Wall Street Journal. I devour every word in Kaiser Daily, Modern Healthcare, HHN and other top tier trade publications to stay abreast, and devote my airplane hours to Health Affairs, the New England Journal of Medicine (NEJM) and Journal of the American Medical Association (JAMA) to round out my vista. I listen when Christine Romans and Sanjay Gupta opine on CNN about healthcare news items like Zika, the drug price controversy and others. But it’s not enough. I still find myself confused by contradictory studies and am frequently at-a-loss to understand the complex issues that are pervasive in our industry. And I live in it everyday!

Essentially, our industry operates out of sight, out of mind for most Americans until we debate a major law like the Patient Protection and Affordable Care Act or hear soundbites at election time.  Our views about healthcare stem not from a studied understanding of how the industry is structured and regulated, butfrom our personal experiences and anecdotes. Polling by Pew, Harris, Kaiser and others show opinions about healthcare are strong, but understanding of the issues being queried weak. Our societal ignorance about our health system is a debilitating pandemic*. It satisfies the soundbites used by politicians, reinforces widespread misinformation and myths, and explains why healthcare gets page one coverage for its shortcomings but rarely its accomplishments and complexities.

We need more, not less, coverage.  We need an informed electorate equipped to understand how the system operates, how it accesses its capital, how it purges its bad actors, and how it devises better ways to diagnose and treat diseases. We need deeper discussion about the trade-offs that are perplexing our industry: how to pay for new therapies that we demand first in the USA, how to change incentives in our system from doing more to doing the right things well without admitting blame for unnecessary care and exposing the allure of our profits, how to balance care for the sick and appropriate more to preventive and mental health, how to purge unhealthy food and bad air quality from our communities so healthiness is achievable, how to die with dignity an purpose, and how to juggle the vastly different views of seniors who count on Medicare and those younger strapped with these costs.

There are five things we can do if we’re serious about an informed electorate for healthcare:

1-We can build into our elementary, secondary and post-secondary educational curricula required courses so students get more than one chapter on healthcare that’s optional.

2-We can accelerate access to our personal medical records and online tools that equip us to understand our risks, options and costs.

3-We can require our elected officials to know the industry sans teleprompters and party messaging tip-sheets.

4-We can watch and read networks and periodicals that offer a consistent, substantive coverage on healthcare that connects the dots between our one-day stories.

5-And we can dedicate more resources in our organizations and trade groups to public education. This is not the time to shy from public relations efforts and informational campaigns.

As British philosopher Alfred North Whitehead said, ‘it’s not ignorance, but ignorance of ignorance, that is the foe of knowledge”. Until and unless our society takes healthcare ignorance seriously, we’ll see costs increase, gaps between those with coverage and those without widen and growing discontent about its performance. It’s a pandemic that threatens the system itself with ramifications far beyond our borders.

Paul

pkeckley@paulkeckley.com

www.paulkeckley.com

P.S. There have been 4 substantive studies about the prevalence and performance of provider sponsored health plans since 2015. Tomorrow, at the Healthcare Financial Management Association’s Annual Summit, I will be presenting a review of these and forecast for what’s ahead. In next week’s report, we will summarize these findings. Stay tuned.

*Pandemic: “an infectious disease that spreads across an entire country or region”