Health or Something Like It

The United States healthcare system is at a critical axiom point. The U.S. spends more on healthcare per person than any other country, accounting for nearly 20% of the worlds largest economy. Despite spending, life expectancy in the U.S. is lower than many other developed nations; and we have the highest rate of preventable deaths in the world. Anyone that has attempted to go to the doctor can likely attest that it is shockinging difficult to get extremely simple things done - like filling medications, getting into a specialist in less than six months. Worse yet, depending on your insurance plan, it can also cost obscene amounts for the most basic (poor quality) care.

The current system is designed around the provision of healthcare. Billable covered service codes measured in fee-for-service units that only pay for outputs, not outcomes. Said another way, we are focused on producing healthcare, not health. 

If we focused on health, then Payers and Providers would work much more closely together - through capitation with up and down side risk. Providers wouldn't have to focus on how many billable service codes they could squeeze into an encounter and would focus on what does the patient actually need. We wouldn't need to schedule appointments for largely administrative reasons such as specialist referrals, medication refills etc. Providers would have the flexibility to 'move beyond the code' and deliver services that meet people's needs, without the limitations of 'covered services.' Payers would still have cost control mechanisms for high-cost services and interventions; and patients would have convenient, high-quality care, customized to their needs and preferences not a financial algorithm of limited covered benefits. 

There are dozens of case studies and models to achieve health. We simply need to increase awareness of them and migrate the system toward health, not just healthcare.