America's health care conundrum
The reality of our health care system is that it is enormously complicated, redundant, inefficient and extremely wasteful.
Since we do not consider health care to be a right of citizenship and insist that it ought to be a marketable commodity, we have fashioned health care to reflect the conflicting voices of many decades.
Incremental reform, which usually translates often poorly into another Band-Aid fix, is how we move the elephant around the room.
Having spent 30-plus years in our health care system, I know the issues are far from simple. Yes, we would all be better off if we adopted a healthier lifestyle, but we rarely do. There are few elective health care choices where consumers may gain sufficient knowledge to select the most cost-effective provider, whose track record reflects quality outcomes.
Yet, for the most costly health care, which is usually not elective, the choices become limited or totally unrealistic. During urgent and emergent situations, the consumer is rarely an active participant in health care delivery choices.
Most providers are ethical and take pride in the care they deliver.
But make no mistake, when it comes to money, there are endless ways to "create" additional income, legit or not.
The drug manufacturers complain that the cost of research drives the cost of drugs, when in fact, most research is all or partially funded by government (you and me).
Malpractice impacts the cost of care, mostly by prompting providers to practice defensive medicine, but clearly is a small, yet significant component. Insurance companies do what they do best make money while providing enough coverage to avert legal entanglements. And, the reality of health care (as with all human services) is there is no end to the "need" and desire of humankind.
So, health care is much like a water balloon. No matter where you press, the bulge will emerge elsewhere. To change this conversation, we must adopt a different view. If we believe some health care ought to be available to all, we must make it affordable. This means we must all contribute, there must be a budget and we must decide what constitutes "basic" health care.
Alternatively, we could decide that health care is totally private and if you can't pay, you go without. Today, we operate under the belief that someone else pays for the care of the 50 million uninsured and the roughly equal number of underinsured. Not true. All these people (your family, friends, neighbors) either defer care until it is a crisis, at which time the cost of care is the highest, or many die or become unnecessarily disabled, at which point they become dependent on government support.
All of it is paid by you and me.
Would it not be reasonable to base a health care system on the realities of our lives, rather than persist in doing more of what doesn't work and expect better outcomes? All systems have challenges and will require constant vigilance and adjustments, much like our own individual lives.
Liana B. Teteberg has been a consultant in health care systems for 20 years, working with health plans and medical groups in development and implementation of Medicare, Medicaid and commercial health care delivery programs. She lives in Park City.
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