Some things never change - a reflection on the live of Dr. Victor R. Fuchs

The dean of healthcare economists, Victor R. Fuchs, is dead. While we mourn his passing, and recall his profound influence, it's worth reflecting on a sobering fact—healthcare is even worse today than it was in 1975, when Dr. Fuchs released his famous book, Who Shall Live? Health, Economics and Social Choice. At the time, Who Shall Live? was required reading for health professionals. (And it still is, if the recently released 3rd edition is any indication). In the book, Dr. Fuchs noted that American healthcare policy was on the wrong track. Sadly, that is still the case. According to The New York Times obituary, "Some considered the book unseemly. There was something distasteful, his critics said, about applying economic analysis to a field concerned with life and death."

In the decades since, one could confidently come to the opposite conclusion. Namely, that we're not applying enough economic analysis to life and death. For example, America is still spending more and more on healthcare and doesn't have anything to show for it. Our healthcare costs are twice that of other advanced countries, and yet our outcomes are lackluster. Some things never change. During his career, Dr. Fuchs identified the biggest problem facing the U.S. healthcare system—a lack of willingness to make hard choices. Real change will require both policy makers and the public to make tough tradeoffs. Unsurprisingly, that still has not happened, and the consequences of continuing to evade reality will only serve to compound our problems. In order to contain costs we need to prioritize primary care, emphasize affordable end-of-life care (e.g., hospice) and escape the clutches of the coding system, which shackles physicians and burdens everyone with bureaucracy. Implementing these three changes would dramatically increase access to care, improve the quality of care and reduce spending. For those interested, my book, The Journey's End, offers a roadmap for making this happen.

Of course, you don't need to be a dean of healthcare economists to see the value in that.

Talking about the Business of Healthcare on November 14

I'm excited to be on a panel titled "The Business of Healthcare: Understanding the Value Equation from a CEO and CFO Perspective" at Becker's Hospital Review's 11th Annual CEO + CFO Roundtable, taking place at 10:40 a.m. on Tuesday, November 14 at the Hyatt Regency in Chicago. I'll be alongside Darryl Linnington, Chief Financial Officer, Hollywood Presbyterian Medical Center; Phillip M. Kambic, President and Chief Executive Officer, Riverside Medical Center; Anisha Sood, Chief Financial and Strategy Officer, First Choice Health and Jennifer Wandersleben, Chief Executive Officer, AdventHealth West Florida.

View all the sessions and learn more about this meeting here. #BeckersCEOCFO

Why is old age so unhealthy in the US?

Jessica Hall asks a wonderful question: Why is Old Age so Unhealthy in the US?

More importantly, her article offers valuable insights into the grim realities of healthcare in your waning years. Hall offers us a new way to measure and evaluate the last stage of life - Healthy Life Expectancy. This metric attempts to distinguish between life expectancy and a healthy life expectancy. In other words, it compares your healthy length of life to your total life expectancy.

In short, living longer is not the real goal, rather living longer healthfully is the real goal. Take Japan vs. the US, for instance. In the US, our life expectancy is 78 (ranked 40th in the world). Yet our healthy life expectancy is only 66.1 (ranked 68th in the world). That's a significant drop. By contrast, Japan has the longest life expectancy at 84.3 years, and the longest healthy life expectancy at 74.1.

So, why does the US rank so poorly throughout the world? After all, the U.S. spends virtually double what these other advanced countries spend on healthcare. The obvious conclusion is that the US is spending its healthcare dollars on the wrong care.

Hall's article sheds light on this situation: “In recent decades, we have successfully extended our lifespans - [but] the years of dependable good health - have not kept up, remaining at an average age of 66 years. Americans will spend 12 years living with a disability or serious disease - and people do not want to spend the last 12 years with the wheels coming off…”

These facts should be of tremendous concern to health policy experts. Given the rapidly aging population and the burden of healthcare in the US, these realities call for a dramatic change in our healthcare policy.

Two reform opportunities standout above all the others: 1. Recenter the importance of primary care. 2. Implement well documented care models for end-of-life care. These two areas of focus should be how we shift US healthcare policy and investment.

If these topics pique your interest, you may wish to read my book The Journey’s End.