Guest Post by Tom Emerick
When I travel around the U.S. giving speeches I often ask for a show of hands of people who have had relatives harmed by a major misdiagnosis, bad surgery, botched treatment plan, etc. Nearly every hand in the room always goes up and everyone is always incredibly surprised to see this. I then share that if they know ten people who have died of cancer, likely three of those ten were misdiagnosed and given a useless or harmful treatment plan. Jaws drop, but it’s true.
I follow this with “how are we spending $3 trillion on a healthcare system that is harming so many people?”How is this happening? We’ve all seen bad medical events with our own families and friends, but we don’t realize how common and costly it is.
This is also the core insight behind what’s wrong with the U.S. health care system.
I’ve had the unique experience of being behind the scenes for more than 30 years. This has let me identify seven high-level systemic problems with the US health care system. All are the result of various flawed incentives Dave covers in the following pages. These problems enormously damage our country, both individually and collectively. This book addresses these issues and practical solutions in a systemic way I’ve not found elsewhere.
1. Lack of accountability
Health care providers aren’t accountable to anyone for the quality of care provided in the U.S. A clinician can misdiagnose 20-40 percent of patients, which many do, yet nobody prevents it or stops them. The biggest care quality failure is misdiagnosis. Anything that follows harms you and your wallet. Data shows that misdiagnosis rates in some categories of major care are 20-40 percent! We have an epidemic of misdiagnosis.
2. Status quo lobbying power
Health care institutions in America are very powerful. Few, if any, sectors of our economy have more powerful lobbies at both the national and local levels than health care providers and health insurers. They have $3 trillion reasons to protect the status quo and spend more than anyone to protect it.
3. The American health care exceptionalism fallacy
There is a fallacy in the U.S. that we have the best health care. This is simply not true. We may have the easiest access to care or the most providers in certain categories. However, the cost and quality of this doesn’t really stack up to our peer countries in any critical systemic metric. Our health care is twice as expensive with significantly worse results.
4. Limited individual purchaser influence
The individuals and corporations that pay for over half of health care lack the individual power or influence to offset that of our collective health care institutions. Our government pays the other half, yet even Medicare and Medicaid do a poor job of managing many issues, including the widespread misdiagnosis and over-treatment of patients discussed in Dave Chase's book CEO's Guide to Restoring the American Dream.
5. Widespread conflicts of interest
The world of health care insurers, providers, vendors, buyers, brokers, and advisors is a bizarre world rife with conflicts of interest we just wouldn’t accept elsewhere in society. For example, benefit managers generally hire benefit consultants paid by health insurers and providers. This is a textbook conflict of interest. If Fred hires Bob to sue Joe, Joe would be off his rocker to hire Bob to defend him. Yet this kind of nuttiness is the default approach throughout the purchasing, administration, and delivery of health care in America. Enough is enough.
6. Poor internal financial oversight
Health care plans are one of the biggest areas of spending and financial risks facing public and private employers, yet they’ve been placed in the hands of human resources managers. Taking care of employees is in HR’s DNA and many are very good at it. Unfortunately, this same trait makes many of them poor benefits managers, risk assessors, and financial analysts. Many just have not made the necessary decisions to maximize the quality and minimize the cost of health benefits.
This isn’t from a lack of solutions. They exist. They give employees better quality care, save employees out of pocket spending, and save employers money. Many HR managers are just not willing to shake up the status quo. Alas, the status quo needs to be shaken up badly.
7. Reimbursement is more a wealth transfer than an economic transaction
Expense reimbursement models in health care are not really economic transactions. If a consumer goes to a doctor who treats the consumer, but is paid by a third-party—an employer, insurer, or government entity—this is more a wealth transfer than a classic economic transaction. Market economics do not apply when third parties pay consumers’ bills. Yet this is how health insurance works.
I highly recommend Chase’s book as it explains these problems and the root causes behind them in detail, then offers common sense ways to take control of health care costs and improve the quality of care your employees receive.
It is do or die time. If you think it wise to save our country and health care system, things need to change and change now.
About the Guest Contributor:
Addressing misdiagnosis and overtreatment in cancer, musculoskeletal procedures, organ transplants, and other high-cost areas has a greater impact on patients than any blockbuster drug. Tom Emerick has more experience with these types of claims than most, if not all, benefits leaders. He was Walmart’s Global VP of benefits and ran benefits at Burger King, British Petroleum, and American Fidelity. He’s the author of Cracking Health Costs and created one of the first centers of excellence programs for large employers, subsequently making it accessible for any self-insured employer. He’s been walking the path this book lays out for decades.