The following is an excerpt from Navigant Healthcare’s Pulse Weekly. Click here for a complete copy of this week’s article.
At the opening ceremony for the London Summer Olympic Games on July 27, 2012, the host country paid tribute to its National Health Service, deemed a “national treasure” by film director Danny Boyle in a 20 minute spectacle featuring 600 nurses. The British press carried this theme:
“The rest of the world may have been perplexed, but it was 20 minutes that made Britain feel better about itself. The dancing doctors, the nurses in their old-fashioned uniforms, the cute children bouncing on 300 luminous beds that spelt out those sacred three letters: NHS….Amid the dark satanic mills and pogoing punks, here was a special moment to give thanks and praise to something British that we deem the envy of the world.. After all, our doctors are deities and the National Health Service is sacrosanct — the one arm of the State beyond criticism.” (1)
Since passage of the Affordable Care Act (ACA) in March 2010, our healthcare system has been prominent in U.S. news coverage. Of late, it has captured press attention about its handling of the Ebola virus victims and excessive waiting times for veterans in Phoenix and elsewhere. And most recently, it attracted coverage for comments by MIT Professor Jonathan Gruber’s that consumers are “stupid” about the health system prompting Congress to schedule a hearing to dig deeper into the veracity of his assessment.(2)
Data about the performance of the U.S. health system is fairly straightforward: compared to systems of care in other developed countries of the world, the U.S. system is the most expensive by almost 2:1 and is first to deploy the latest technologies and therapies in its hospitals and medical practices. The U.S. market is half the world’s spending for drugs, and 6,000 medical device and technology companies call it home. It ranks 38th out of 191 by the World Health Organization for life expectancy; 15% of our citizens have no health insurance and medical debt contributes to 62% of our personal bankruptcies.(3) These are well documented facts.
Opinions about our system of care are more complicated. To illustrate, polling about the Affordable Care Act: the country is divided about whether the ACA is good or bad, but elements in the law, like disallowing insurance companies from denying coverage due to pre-existing condition and coverage for adult children under 26 on their family’s plan are wildly popular.(4) Studies by RAND have shown that ratings of a hospital/physician’s performance are not associated with clinical outcomes or quality, but service delivery and affability.(5) Little wonder why there are hundreds of hospitals advertising as a “Top 100” hospital. But when compared to overall perceptions of public education and the effectiveness of government, healthcare fares well, perhaps because its costs are buried in across a myriad of pass-through’s in the goods and services we buy or taxes we pay. For most Americans, the cost of healthcare is not a line item like a mortgage payment or rent: it’s a co-pay here and a premium there, with additional out-of-pocket for over the counter medications, or unplanned visit to the emergency room. They add up - healthcare discretionary spending in the average household is second only to housing at $16,000/year, and they’re increasing faster than wages. (See Bureau of Economic Analysis data in Fact File section.)
For the majority of Americans, how our health system operates and how other systems compare are unknowns. We anchor our views in our personal experiences, not data and facts. And our views don’t change unless altered by a life event with a disappointing outcome—an accident, hard to treat condition, loss of insurance coverage, or bankruptcy as a result of medical debt. So Americans feel strongly about our health system based more on perception than fact.
In 2007, the documentary “Sicko” was released by American filmmaker Michael Moore. It focused on the U.S. health insurance and pharmaceutical industries and offering a flattering view of universal healthcare systems of Canada, the United Kingdom, France and Cuba. In my comments on CNN, I was conflicted: yes, the U.S. system has flaws, but also enormous strengths that carry a high price. It needs improvement, but the public’s appetite for dramatic changes is problematic: our understanding of system alternatives is minimal, our aversion to a bigger government role in healthcare is palpable, and for the majority of Americans who have health insurance of some sort, our occasional discontent is manageable. In the exchange with Mr. Moore, the fact that 1 in 6 goes without insurance coverage, and ours of a capitalistic enterprise where profits are rewarded were conceded. But missing in that exchange, and still at issue: how our system can best engage individuals to be accountable for their health, and what to do about those lacking coverage short of a single payer alternative. It was a testy exchange, but it illustrated to me the emotion and passion we have about our healthcare system.
The greatest challenge facing the U.S. health system may be public awareness based on objective facts. Perhaps we need a no-spin zone about our healthcare system — what works best to diagnose and treat, how incentives drive its behaviors, how money flows, where there’s waste, and how to get more bang for the buck (value).
That zone doesn’t exist. As a result, misinformation prevails, the public’s opinions about healthcare is often ill-informed, and efforts to address its flaws are undermined so the status quo is protected.
Educating Americans about how the health system operates and how it can be improved might take generations. Perhaps starting in grade school, tutorials about how the health system operates could be introduced via a video game or creative classroom materials. Maybe In high school, a required course could be added to the curriculum. For healthcare workers—doctors, nurses, allied health professionals and others—requirements that they take classes and continuing education could be requisites for licensing. And for healthcare journalists and elected officials, increased transparency about the factuality and reliability of statements could be helpful.
I doubt thankfulness for the U.S. health system was dinner table talk last Thursday and I’m confident its tribute will not be part of Super Bowl XLIX coverage on February 1. But as 2015 approaches, maybe our resolution should be to refresh our discussion about the U.S. health system sans the politics of health reform so we, like the Brits, might think of it as a national treasure.
(1) Bryan Birrell, “The London 2012 opening ceremony, and a night that set NHS reform back years,” The Mail, August 3, 2012
(2) Jeremy Diamond, “Jonathan Gruber agrees to testify in House,” CNN.com, November 25, 2014
(3) Joanne Cochran, “Take care: Why America needs health care reform,” Public Opinion Online, November 22, 2013
(4) Bloomberg News National Poll, Study #2102, Conducted by Selzer & Company, June 6-9, 2013. N=1,005 U.S. adults. Margin of error: ± 3.1 percentage points.
(5) "RAND study finds patients' ratings of their medical care do not reflect the technical quality of their care," (Press release). RAND Corporation. May 1, 2006
In today’s Fact File, additional documentation referenced in this commentary is provided.
The opinions expressed in this article are those of the author and do not necessarily represent the views of Navigant Consulting, Inc. The information contained in this article is a summary and reflects current impressions based on industry data and news available at the time of publication. Any predictions and expectations noted herein are inherently uncertain and actual results may differ materially from those contained in this article. Navigant undertakes no obligation to update any of the information contained in the article.
© 2014 Navigant Consulting, Inc.