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Giving Thanks for What's Right With Our Health System

Those of us working to improve the health system sometimes joke that at least we'll never be out of a job, because there's always so much more that needs to be done.
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Robert Derzon Chair in Health and Public Service at NYU

Robert Derzon Chair in Health and Public Service at NYU
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Those of us working to improve the health system sometimes joke that at least we'll never be out of a job, because there's always so much more that needs to be done. The magnitude of the challenges we face can seem daunting: we spend too much money to achieve often mediocre outcomes; we are under-invested in actually keeping people healthy, with many more resources focused on treating illness rather than preventing it; too many people still lack access to the care they need.

But with Thanksgiving approaching, I am also thinking about what's working in our health system, and the things we have to feel thankful about. When my relatives try to tell me over the holidays how broken our health system is (and when they rib me for not doing enough to fix it), here are three things I'll tell them we should celebrate:

  1. More people have health insurance. Approximately 1 million New Yorkers gained health insurance coverage through the first open enrollment period after the Affordable Care Act was implemented. More will enroll in Medicaid and private plans during the current open enrollment season, which goes through February 15. And they're not just signing up: a recent poll found that 92 percent of newly-insured New Yorkers are satisfied with their coverage, and 82 percent of those surveyed say that they are actually using their coverage for range of health services, from primary care check-ups to medications to dental care. It's clear that health reform is working in New York, even though we still have more work to do to ensure that coverage and care are affordable and meet the needs of consumers. I trust that market forces and consumer advocacy will lead to improvements in offerings within the Exchange.

  • There's real momentum for tackling health care costs. We have been talking about "bending the cost curve" in health care for as long as I can remember, but it seems as though energy and momentum are growing to make it actually happen. New payment approaches are moving away from a focus on rewarding the volume of care (the more tests and services, the more a provider earns) and toward encouraging high-quality care that keeps patients healthy and delivers good outcomes. Here in New York State, we are all focused on DSRIP (the Delivery System Reform Incentive Payment program), which ultimately aims to reduce hospital admissions and health care spending. By no means is payment reform a done deal, and I think we'll have some version of a fee-for-service system for quite a while. But we seem to be moving in the right direction, poised for big changes that will make health care more rational and more affordable for patients.

  • We're making progress on childhood obesity. Granted, this may not be the best talking point over mashed potatoes and pumpkin pie, but we should feel good that we're starting to turn the tide when it comes to childhood obesity. Earlier this year, it was reported that obesity rates among New York City students in kindergarten through eighth grade had dropped by 5.5 percent over a four-year period. A comprehensive approach to curbing obesity among young people -- one that includes interventions both in schools and in neighborhoods -- is credited with making the difference. And the approaches that have worked to halt childhood obesity are helping us learn what it will take to get us all eating better and moving more.

    • I'm sure that we will argue about Obamacare at my family's Thanksgiving dinner; we will fight about who the villains are in the health system; we will ponder the relative importance of personal responsibility and genetics and environmental factors when it comes to how healthy we are. That's family, and it's as American as apple pie. But I'll also take a moment this Thanksgiving to think about how far we've come and how much promise our health system holds.

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