My health wish list for the next administration

A new health reform movement is on the rise, led by two Stanford surgeons, Casey and Calley Means, and a Johns Hopkins surgeon, Marty Makary. They both have authored best-selling books which detail their research (the Means' book isn’t #1 on the NYT list). Ironically, their research powerfully illustrates that the US food system, the overuse of drugs and the health systems’ economic incentives are the primary cause of our health system crisis. 

For example, the US food system adds up to 10,000 different chemicals to our food - often designed to create addiction/overeating. Compare this system to Europe, where only 400 chemicals are allowed in the food system. These experts argue that food toxins are a more significant issue impacting health than smoking!

Or let’s look at our healthcare economic incentives. The “quality and merit” criteria used by Medicare for physicians in MIPS and QQP and also used for Medicare Advantage Plans and ACOs have all the wrong incentives. These specific quality metrics are primarily based on whether doctors prescribed drugs regularly or did more interventions. Yet there is no evidence that these practices have improved health outcomes. These measures are process measures - not outcome measures. This criticism applies to hundreds of metrics for a multitude of conditions 

Not only does this “quality and merit system” not work, it costs billions in terms of administrative cost. The worst impact of this system is that doctors spend more time completing administrative work than they do seeing their patients. No wonder we have a physician morale problem.

Or let’s look at drug utilization. The only countries in the world that allow pharma to advertise directly to the public are the US and New Zealand. The average American sees nine drug ads a day. Pharma is the largest media advertiser so a media investigation into this problem is unlikely. These ads allegedly inform consumers, but evidence suggests they mislead consumers and interfere with the physician-patient relationship.

My book www.thejourneys-end.org has a similar focus, essentially that healthcare has medicalized death by over treating the elderly. This over treatment is heavily related to the health systems' economic incentives and the overuse of pharma. 

Combining the Means’ wish list for the next administration with the wish list in my book would be both feasible and a powerfully positive approach to reforming healthcare.

Why improving primary care matters

Here's another compelling argument that describes how improving primary care is the key to improving healthcare.

Abuses made possible by coding

Let me briefly connect some dots on the Wall Street Journal’s (WSJ) recent coverage of private Medicare Plans known as Medicare Advantage (MA) plans. The investigation of this 11/14 article concludes that the sickest patients eligible for Medicare are “fleeing” MA plans because of inadequate insurance coverage. At the same time, these private plans collect 20 percent more from the taxpayers for their patients because the MA plans claim they care for sicker patients. The MA plans use coding to assert that their patients are sicker. This 10/24 WSJ article offers compelling evidence that the MA plans manipulate the coding system (rather than care for sicker patients) to receive higher taxpayer payments.

To make matters worse, MA plans also pay less to doctors and hospitals for care than regular Medicare. They achieve this outcome by denying claims and paying providers lower payments. This lower payment level has caused providers to cancel contracts with MA plans because they are losing too much money on these contracts, as noted in this USA Today article.

In summary, taxpayers and Medicare are overpaying MA plans by billions of dollars, and patients and providers are being harmed by these plans. The coding system, which is ridiculously complicated and easily manipulated, makes all this abuse possible. These abuses will continue as long as healthcare utilizes coding to determine insurance and provider payments. Alternatives to coding exist for paying providers and insurers. Visit www.thejourneys-end.org to learn more about these options. Hopefully, the new Administration will be open to these innovative solutions.