Sunday, August 20th, 2017

Thoughts on the Healthcare Debate


by Dr. Lewis Zulick

Healthcare in the United States generates headlines every day as our congressional leaders debate how to provide the best healthcare for the most people. The stakes are high. Almost everyone requires healthcare at some point in their lives and it is a source of employment for 9% of the workforce.

The practice and delivery of healthcare has exploded in the last 30 years as a huge number of tests and treatments have been developed for an ever-increasing number of conditions while, at the same time, an expanding fraction of the population over 65 has created increased demand for those services.

We can envision a healthcare system that provides every patient with every possible test or treatment according to the desires of the patient and the recommendations of their doctor without regard to cost. I would argue that our healthcare system does presently provide something close to that. As a result, we have seen a growth in healthcare costs in this country of about 4% per year.

Most people would agree that providing every possible test or treatment for every person is not realistic and that healthcare costs must somehow be controlled. One seemingly obvious way to do that is to simply provide fewer resources for healthcare by limiting coverage. But we know that taking away healthcare coverage for a segment of the population does not mean reducing costs: those people still access the healthcare system and care is provided through other sources of funding.

Fortunately, there is another avenue for decreasing costs and one that everyone can agree on: by increasing the efficiency and quality of healthcare delivery. Those savings are real, long-lasting and, by the way, make people healthier.

Creating policy that will improve efficiency and quality in healthcare is a hard job but also what we should expect from our congressional leaders. Doing so cannot be achieved without using data to determine which tests, treatments and healthcare delivery models are most effective and at what cost. During the current debate I have heard very little mention of a data-driven approach to either manage healthcare delivery or to increase quality and efficiency. Without a commitment to that approach, there is little expectation that our costs will be controlled. Things will likely continue as they have which is not necessarily a disaster: many if not most people are well served by our present healthcare system. But, we can and must do better because the current rate of increased costs is not sustainable.

Innovations in the prevention and treatment of disease over the last 30 years have been nothing short of amazing. Those innovations would have been impossible without careful research and attention to data that told us what works and what doesn’t. We must use the same intelligence, compassion and hard work to make those innovations available to everyone at a cost we can afford.