Is The US Healthcare System Terminally Broken? – Forbes

UPenn bioethicist Ezekiel Emanuel argues the U.S. healthcare system can be fixed by scaling up innovative care models that have been deployed successfully in various regions of the country. (Photo by Neilson Barnard/Getty Images for Klick Health)

With Congressional efforts to repeal and replace Obamacare in the rear view mirror—and replaced by President Donald Trump’s vows to sign executive orders that many fear would severely cripple the law—there’s a lot of pessimism out there about the future of the U.S. healthcare system. But is the system terminally broken?

Four healthcare experts sat down recently at the Mayo Clinic Center for Innovation’s annual conference to debate that exact question. The winning contenders in the debate—who were crowned after polling both the live audience and those following along on the Web—had an answer to the question that may seem surprising. Yes, the healthcare system is struggling, they argued, but the problems are fixable. Therefore it is not terminally broken.

Making the case that healthcare can and should be fixed were Ezekiel Emanuel, a bioethicist and vice president for global initiatives at the University of Pennsylvania, and David Feinberg, CEO of Geisinger Health System. The crux of their argument was that there are many “points of light” in the healthcare system—regional health insurers with innovative business models, for example—that have been successful. If the country could take elements of those models and scale them up, that would go a long way towards fixing the system.

“Are we beyond fixing?” Emanuel said. “I’m an oncologist, and I will tell you, we are not terminally ill. Sick, but not terminally ill.”

Emanuel then described examples of healthcare delivery models in various parts of the country that he says are working well. For example, CareMore’s Medicare Advantage plan in Southern California provides plans to chronically ill elders who are “much sicker than the average Medicare patient,” he said. “And they do phenomenally well. They have 45% fewer hospital admissions than regular Medicare. Their readmission rate, if you control for risk, is 10%, compared to Medicare’s average of 17%.” Similar positive metrics can be found in small health plans in Hawaii and Tennessee, he added.

Feinberg described many initiatives being pursued at Geisinger aimed at improving the health of its patients, including sequencing the genomes of 100,000 people at no charge to them. “We look at their DNA, and about 4% of those people have medically actionable conditions that we can intervene with before the bad thing happens,” he said. “On those cases, there are probably about four first-degree and second-degree relatives that are also affected.” Such proactive approaches should lessen the overall strain on the healthcare system by reducing the incidence of and complications resulting from chronic diseases, he argued.

Still, all of the debaters agreed that scaling up these ideas would not be easy. Part of the problem, they said, is that doctors are still largely paid on a fee-for-service basis that often rewards them for administering treatments that are not always effective. Emanuel explained that oncologists are still rewarded for administering chemotherapy, for example, even if newer treatments may be more effective.

But for more innovative care models to be embraced, they would need to be mandated, argued Shannon Brownlee, senior vice president of the Lown Institute, a health advocacy organization. Brownlee, whose role in the debate was to argue that the healthcare system is terminally broken, wondered who would be responsible for doing that.

“The innovation has to bubble up from underneath, but there are some things that have to be imposed from above,” Brownlee said. “The shift in payment has to be imposed. So who’s going to do the imposing? Medicare hasn’t done it yet.” She also expressed doubts that private insurers would widely embrace alternative payment models.

Yet even Brownlee seemed unable to commit to the idea that the healthcare system can never be fixed. “I find myself agreeing a great deal with what my opponents say,” she admitted. The debate was streamed by Intelligence Squared U.S., with polling taking place before and after the discussion. (See video below.)

Turns out most of the people who tuned in for the discussion were also unwilling to leave the healthcare system for dead. Just over half of the Mayo Clinic conference attendees voted that the system is not terminally broken, as did 86% of the online audience.

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