The Circular Firing Squad in U.S. Health Care

Who is to blame for the U.S. healthcare crisis? JAMA has published an opinion piece by three physicians illustrating a fundamental difficulty in identifying the causes of the healthcare crisis. Individuals construct “casual stories” to assign blame. Subjective narratives gain momentum among researchers, policy makers, journalists, and the public:

  • Payers: Insurers create barriers to health care (high deductibles and gatekeepers) and excessive administrative waste (billing and coding).
  • Life Science Industry: Manufacturers saddle patients and payers with excessively high prices and underinvest in novel therapeutics.
  • Physicians and Hospitals: Financial incentives have led clinicians and health care organizations to focus on delivering volume over value. Hospitals overinvest in high margin services (cardiology and oncology) and underinvest in essential services (obstetrics and psychiatry).

  • Patients: Detrimental health-related behaviors contribute to high-cost chronic conditions. Healthy individuals subsidize unhealthy individuals.
  • Lawyers: Predatory litigation drives “defensive medicine” practices. Fear of litigation leads to wasteful use of services. The current malpractice system is inefficient in compensating patients and punishing negligence.
  • Government: Costly regulations and bureaucratic requirements stifle market forces that would otherwise drop health care prices through competition and consumer choice.

The result of these one-dimensional narratives is reactive policy with stakeholders engaged in turf wars and blame. Meaningful reform will only take place after “open, multi-stakeholder discussions and a focus on consensus based policy solutions”.

The authors do not address how this will happen in a hyper-politicized environment.

Comments (8)

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  1. Jake Sanders says:

    American politics; a beautiful disaster.

  2. civisisus says:

    Jake, how do you read this simple & fairly uncontroversial post about systemic institutional dysfunction in health care and get “American politics” out of it?

    You really need to step away from all the ideological rigidity in your tiny worldview & get some oxygen. You’ve clearly been sucking up the fumes of the likes of John Graham & Devon Herrick for too long.

    • John Fembup says:

      I agree. Health care is the only area of American life in which one finds systemic institutional dysfunction.

  3. Wes Baker says:

    The JAMA piece reads well, the biggest takeaway is that the US health system should be casted as a whole entity and acknowledge that policy problems and inefficiency stem from inadvertent and unforeseen causes attributed to the whole rather than to stakeholders.

  4. Michael Ainslie says:

    Simple answer to our problems:
    1. Give patients back their money
    2. Get the hell out of the way.

  5. Erik says:

    This is an explanation of why the Kaiser/ACO model works best. Everything under one house.

    But the wealthy will always demand more and tip the pony.

  6. Big Truck Joe says:

    So these are the problems in healthcare. Thanks for pointing out the obvious. Now please tell us the easily implemented and low cost solutions. (Que sound of crickets…)

  7. Devon Herrick says:

    “open, multi-stakeholder discussions and a focus on consensus based policy solutions” sounds more like how a cartel would carve up and divide the spoils of dominating a market segment. Isn’t that what we have now? It’s certainly not the solution to what is causing our dysfunctional health care system.

    Doctors have a cartel over the practice of medicine. Every decision made in our health care system involves a doctor. Hospitals are consolidating and acquiring physician practices to maintain their profit margins. Hospitals promoted the idea of coverage nearly a century ago as a way to ensure they got paid. Insurers spent years raising premiums because that was easier than fighting doctors and hospitals on cost. Many employers merely though of health coverage as a cost of doing business, since they could pass on much of the cost to workers. Workers didn’t really understand they were paying the premiums indirectly. Once insured, patients have an insatiable desire for costly medicine — even when it’s of margin value.

    See what I mean? What we currently have is multi-stakeholder agreement to maintain the status quo! It’s not working!