This month the Supreme Court will issue a decision on the constitutionality of the Affordable Care Act, and if you've been confused by the surrounding political posturing and hyperbolic media coverage on healthcare, you're not alone. In fact, almost three years ago, this confusing discourse inspired me to research the topic and, ultimately, begin production on my new documentary ESCAPE FIRE: The Fight To Rescue American Healthcare, which will be released this fall. Simply put, we've been having the wrong debate, and it's time for Americans to start focusing on the systemic problems and tangible solutions, or "escape fires," that are right in front of us.
So far the heated arguments have somewhat missed the point. Yes, increasing access to care for all Americans is incredibly important. But bringing thirty million more people into an already broken system isn't going to fix the underlying problem: we have a disease-care system, not a healthcare system. As Dr. Don Berwick says in our film, "it's not just the health of healthcare, we're talking about the health of the nation."
You've probably heard how expensive our healthcare system is, but the facts bear repeating: we spend over twice as much as other developed nations per person. Healthcare costs are rising so rapidly that they could reach $4.2 trillion annually, roughly 20% of our gross domestic product, within ten years.
In our current system, healthcare companies -- pharmaceutical, medical device manufacturers, insurance, hospital chains -- are getting rich while small businesses are getting crushed. Coverage for the average worker's family costs small businesses $11,000 annually. That's money that comes out of paychecks. Or bankrupts a business.
But the problem isn't just about high costs. We might be able to stomach the big price tag if we were getting big value. But we're not. Not even close. Sixty-five percent of Americans are overweight or obese. We rank 50th in life expectancy. Americans are so laden with chronic illnesses -- many of which are preventable -- that we spend 75% of healthcare costs managing diseases we shouldn't have.
What's going on here? Why are we spending more and more, but getting less and less?
The players involved, for the most part, are good people trying to make us healthier. But we've given them the wrong tools and the wrong incentives. We pay for diabetics to get a foot amputated when they are 60 years old, but we don't pay for lifestyle counseling when they are 45 to prevent the disease from taking hold in the first place (not to mention that we subsidize unhealthy, fake food instead of fruit and vegetables).
We have a fee-for-service system that rewards quantity, not quality; profit-driven care rather than patient-driven care. So doctors order more tests, more procedures, and more drugs -- we actually consume more prescription drugs in the US than the rest of the world combined. Hospitals brag to their stockholders about keeping their beds full -- which is simply backwards. Hospitals should be paid to keep patients out of the hospital, not for signing up more and more patients.
We slap Band-Aids on chronic problems, favoring expensive interventions over low-tech, high-touch alternatives that often work just as well. And all this overtreatment isn't just costly -- it's a dangerous killer. According to new reports, as many as 187,000 people die each year from medical error and hospital infection. That would be the third leading cause of death in this country. So while it may be hard to accept, we have to understand that getting more treatment isn't always what's best for us.
Now comes the good news -- there are innovative solutions already at work in communities across the country. There are very smart clinicians, hospital administrators, policy-makers, business executives, and community leaders who are fighting to rescue the system.
At medical centers such as the Cleveland Clinic and Kaiser Permanente, teams of doctors and nurses provide coordinated care, while working for salary instead of getting paid for every procedure. In the military, a Pentagon-initiated task force is supporting alternative approaches to managing pain in wounded soldiers that could reduce the reliance on addictive prescription painkillers. At the University of California, San Francisco, researchers have shown that diet, exercise and stress reduction can reverse heart disease and, after a 17-year struggle, Medicare has finally agreed to reimburse this program. And at large companies such as Safeway, CEOs are creating incentives for their employees to lose weight and quit smoking. The CEOs can potentially save money on their medical bills. Employees get healthier and can save money on their premiums. Everyone wins.
There is a future in which we all win, but it won't be easy to get there. The small contingent of heroes fighting in the name of sanity is up against the status quo, and those who are making money off the current system don't want anything to change.
But we can make the system better if we all take the time to clear up the confusion. The Supreme Court decision will surely be a media spectacle, but it's also an opportunity to change the conversation.
Regardless of the outcome, the issue of access for millions of Americans will remain important. But the more important question is access to what?
We all have a stake in this debate, so let's make sure we're having the right one. The health of our nation hangs in the balance.
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