A Grim Diagnosis: The Current State of Healthcare in the USA

The United States health care system is at a tipping point – it’s that simple. What is not so simple are the problems threatening to push our system – and both patients and providers along with it – over the edge. Despite numerous groundbreaking innovations in medical technology and research in recent years, health care in America has evolved into a fragmented industry plagued by intimidating problems of access and quality. Millions of Americans – rural and urban, minorities and non-minorities, and Democrats and Republicans, etc. – still lack health insurance. Even for those fortunate enough to get care through either the private insurance system (paid for by their employer or the individual they are legally dependent upon) or the newly founded public health care system funded by taxes (yes, this is Obamacare, also known as the Affordable Care Act), the quality of care remains insufficient. None of the issues facing the American health care system are any one person’s fault; they are, however, everyone’s problem.

Since FDR

In the history of the United States, there have been myriad attempts to create national health care coverage, whether through whispers in the Oval Office or through national campaigns. For over one hundred years, presidential administrations have struggled to balance the demands of public interest and private influence; a system that included health care, which is available to all but not necessarily run by the government, was thus produced out of such struggle. Meeting the needs of both the general public – not just working adults but also the young, old, and unemployed – and conflicting private interests has not been successful. Medicare and Medicaid, which, generally support the elderly and impoverished, respectively, are hailed as some of the only successful government-sponsored health care programs to ever be enacted with bipartisan support. However, they still only meet the needs of a small subset of the population. While the Patient Protection and Affordable Care Act – also mentioned under the names Affordable Care Act and Obamacare – passed in 2010 to cover the entire nation, Americans’ accessibility to quality health care remains a struggle. But why, with these seemingly grand developments, is American health care not booming?

Provider burnout, data inaccessibility, and the ever-present issues of legislative stagnation and cost continue to threaten the health care system. Provider emotional burnout is quietly becoming a national epidemic; studies done by Health Care Strategic Alignment Director Tina Nazier, MBA, show that 54% of physicians exhibit one or more symptoms of considerable burnout in their careers – depersonalization and low personal satisfaction seem to be significant factors. While data is captured on every aspect of the health care process, the ability of everyone, from employees of large hospitals to the patients themselves, to access and understand that data is lacking. According to Nazier, hospital executives and their patients alike have a hard time accessing and using data to make decisions. Meanwhile, smaller hospitals and health systems lack the sophistication, personnel, and support necessary to perform data analytics at the level of larger hospitals (comparative analytics for various therapeutic approaches, patient health outcomes, etc.) and therefore need access to data simply to increase efficiencies, cut costs, and improve the inpatient experience. Speaking of costs – well, you might want to take a seat for this next part.

Despite its developed status and relatively solid emphasis on health care spending, the United States remains an incredibly low-performing country in terms of return on such investment. Simply put, given the backdrop of other developed countries, the US spends more with an insufficient return on investment. According to a report from The Commonwealth Fund, eleven high-income countries share a challenge of rising health care costs as a measure of the percentage of GDP. Shockingly – or not so shockingly if you have kept up with health care reports over the past decade – the US stands alone as the leader in spending. To make matters worse for future legislators, costs have only been somewhat managed in recent years due to low inflation because of the recession. That effect of contained costs, however, in combination with fluctuations in administrative Medicaid payments over the years, is likely to wear off soon (Canada seems alone in any curbing of inflation on a sustainable scale) and the US could thereafter see soaring costs, extending its negative lead in the health care investment return game.

The Present is a Gift, and So Are Tax Cuts

In 2018, the health care issue will continue to plague the US and its current presidential administration. By means of the tax reform act – the Tax Cuts and Jobs Act passed by Congress and signed into law by President Trump shortly before Christmas 2017 – the individual mandate penalty required by Obamacare will expire in 2019. The mandate requires Americans to buy their own health insurance or face a penalty if they are not already covered by their employer or by a government program such as Medicaid or Medicare. The new tax law eliminates the penalty beginning in 2019, allowing Americans to remain uninsured without check. President Trump – without Congressional input of any kind – can also cut the subsidies which have partially been keeping Obamacare in play. Specifically, he can also cut the marketing and Public Announcement campaigns for signing up citizens for the program, causing a decrease in enrollments and further threatening Obamacare repeal. Beyond the individual mandate and financial cuts to Obamacare, several other items are also being considered; with the recent success of the Tax Cuts and Jobs Act under their belt, Republicans in Congress are also looking to take aim at “reforming” Medicare and Medicaid. Given the recent outcome of the 2018 midterm elections, however, such attempts will likely be met with strong rebuke.

It’s Not All Bad

Despite the problems stated above, population health remains a top priority for the health care industry. Large hospitals and health systems believe it is their responsibility to pioneer advancements in patient outcomes, and they are delivering with the integration of new medical technology and innovative therapies into their health care models. Small to mid-size health systems are focusing on this as well, despite the added pressure of remaining viable in the current market. Of the many post-Obama administration forces currently transforming the American health care system, none is more significant than the turn from payment based on volume, to payment based on value. Value is driving a fundamental reorientation of the health care system around the quality and cost-effectiveness of care. As in any industry, value in health care is defined through the relationship of two factors: care quality and patient costs. In addition to the new value-based payment system, lab and clinical research – which continues to be the bedrock on which the health care industry as we know it is built – is thriving. Cutting-edge work not only promises to treat notoriously prevalent diseases including cancer, diabetes, and heart disease (three of the deadliest diseases afflicting American patients in the modern era), but also lesser-known diseases including Hepatitis B, various STDs, and various genetic disorders. Predominantly led by researchers throughout American universities, the work being done to innovate the health care industry at its clinical research foundation is extremely promising.

Looking Ahead

While it is true that the current state of the United States’ health care system is unsettling, our current status must not tarnish our perspective of the future. Looking toward 2019 and beyond, Wharton’s Mark Pauly and Drexel’s Robert Field call on Americans to watch for seven key trends in American health care. They include the topics of life after the individual mandate, changes in Medicare and Medicaid, addressing the opioid crisis, prescription drug prices, CHIP (Children’s Health Insurance Program) funding, the dynamic of health and human services, and health care as a jobs-creator. Hopefully, with the information provided in this article, you – and those who legislate as well – can help to better address these issues and, with a bit of luck, keep the American health care system from falling over the edge.