"What would you give up to make American healthcare better?"

 There was a thought provoking article on Bulwark this morning by Ezekiel Emanuel: What Would You Give Up to Make American Health Care Better?

It is thought provoking in the sense of things to think about, but not really tackling the big problems. A few things I would be on board with, and a lot of things I wouldn't be.  

From the article:

"What are you willing to sacrifice for a much better—if not the best—American health care system?” That was the question I posed to a large group of CEOs and other C-suite executives from hospitals, physician groups, health care companies, and other organizations at a recent meeting."

"American health care is totally dysfunctional. And everyone knows it. It is too expensive. Quality is uneven and declining. It is confusing, time consuming, frustrating. Indeed, at this meeting, one senior health care executive said, “the status quo no longer works.” Another—Steve Hemsley, the chairman and CEO of UnitedHealth Group, the seventh-largest company in the world—said the system needs to be “disrupted.”  Ironically, it seems that every discussion about fixing health care ends up focusing on money—and getting more and more and more.... We have to flip our thinking on its head. Instead of asking what people want or think they need, we need to ask people: What are you willing to give up?"

"....An important proviso is that everyone knows that every other participant in the health care system will also give up something. It is only with collective, coordinated sacrifice that we can create a system that will ultimately benefit all Americans—not just torpedo every new reform idea."

I will explore some of the ideas expressed:

"Pharmeceutical companies need to give up monopoly pricing of new drugs and accept that their new drugs should be priced based on how much they improve people’s health." and,   "...Pharmeceutical companies should also give up direct-to-consumer advertising." "...Pharmeceutical benefit managers need to give up rebates, spread pricing, and other hidden charges and accept a fixed administrative fee as part of a transparent pass-through pricing system."

I could go along with those ideas, especially the direct to consumer advertising.

"Hospitals also need to give up charging more for the exact same MRI, surgical operations, and other interventions that are paid much less if done out of the hospital. That is, the need to accept that the cost will be the same regardless of where as specific medical service is provided—so-called “site-neutral” payment." This one I don't entirely agree with. If the costs of the hospital are actually higher. then it's fair to charge more for staffing and equipment.

"But truth is everyone needs to sacrifice something, including those of us who are “consumers” of health care."

I thought hard about that one.  But the honest answer to what I would be willing to give up as a patient is, not a damn thing.  Because the deck is already stacked in favor of stockholders, corporations, and administration. Patient rights have already been stripped down to the bare basics.  Here are a few of Mr. Emanuel's suggestions: 

"Ritz Carlton-like hospitals with exquisite art in public spaces, luxurious reception areas, and fancy, wood-paneled patient rooms. Instead, I would accept old couches, plastic chairs, and kids’ scribbles on display."  I think he has been watching too many "Royal Pains" episodes. I have spent a fair amount of time in hospitals, both myself and accompanying family members.  It wasn't Ritz Carlton level.  More like Motel Super 8.  Which is fine. At least it was decent.

"...I’d accept wait times of, say, ten weeks longer than today for elective hip and knee replacements, spinal fusions or disc repairs, cataract surgery, MRI scans, colonoscopies, and similar elective procedures." This one gets and emphatic, "Oh hell no" from me.  Because there probably already is a waiting time of at least that long for some elective procedures (definition of an elective procedure, not life threatening right now, but has to be done)

"I’d be willing to give up today’s super-low generic drug prices, so long as the higher generic drug prices came with the requirement that the generics are produced in the United States and there won’t be shortages."  I don't really care where the generics were made, as long as they were held to the same standards as domestically produced meds.

The author didn't say anything about corporate game playing, consolidation of insurance companies, hedge funds, stockholder priorities. the whole for-profit system.  If none of those are addressed, nothing much will change.  

Your thoughts?