To fix health care, we need to be screwed

“We need to be screwed!”

Not altogether surprising words to spill out of a college student’s mouth. But this particular student was not talking about sex. She was discussing the U.S. healthcare system—more specifically what she thought it would take for our two political parties to come together to find a reasonable way to control our nation’s healthcare costs.

It was the last day of the semester, the last class discussion in my Intro to the U.S. Healthcare System course at Duke University.  We had spent a lot of time over the semester discussing the runaway cost of American healthcare.  We had explored the many failed attempts, by both the government and private industry, to reign in these costs—Medicare’s DRG program for example; the rise of managed care in the 80’s and 90’s too.

We had read about the many U.S. presidents who had tried and failed to reform the system—from Nixon through Clinton.  And of course, we had explored Obamacare in detail, and we had concluded (as have most experts) that even if the law withstands all challenges, even if it slowly unfolds as scheduled over the next few years, the law will still have little impact on healthcare costs.  The Obama reforms are much better at assuring people’s access to health insurance than they are at controlling the cost of that insurance, a fact that once again reveals its similarities to the “Romneycare plan” in Massachusetts, which has helped 98 percent of that state’s citizens obtain health insurance, but at a staggering cost which the state is now trying to cope with.

In short, we had come to a consensus that health reform would need to be an ongoing process, and that someone, somehow, needed to make the kind of changes that would “bend the cost curve,” as health policy wonks are want to say.

But how will we do that? Perhaps if one party controls the House, sixty Senate seats and the presidency, we can pass additional legislation. But even in that case, that party would need to take on powerful interest groups. Controlling healthcare costs, after all, means reducing the incomes of doctors, hospitals, pharmaceutical companies, device manufacturers and the like. It also means overcoming accusations of “healthcare rationing” from one’s political opponents.

How could any political party overcome that aggregation of forces? That was when my student threw out the idea of us needing to be “screwed.” “When everyone agrees our system is unworkable, that it is broken, then maybe we’ll be forced to work together,” she said.

This provocative comment generated lively debate. (Okay, almost every topic we discussed that semester generated lively debate; Duke students aren’t famous for their reticence.)

“Screwed ain’t going to be enough,” one student exclaimed. He went on to add something to the effect of “We’re already screwed. And yet we still can’t balance our budgets, and still haven’t found a way to keep people from being one major illness away from bankruptcy.” Several more minutes of back and forth debate ensued. The topic: whether the U.S. healthcare system was already screwed or was on the verge of being screwed.

And then another consensus formed: people agreed that we were already in deep trouble and that our political parties still hadn’t found a way to work together, nor had special interest groups ceased their lobbying for their interests over the good of the public. The room became downcast.

Then another student came to the rescue, with, I guess you could say, a glimmer of hope: “We will fix the problem, we will.  We just need to be super screwed!”

And that, my friends, is not only a promising title for my next book, but is also the way our semester ended.  With the awful hope that our healthcare system would become just enough worse to force us to fix it, hopefully before the damage to our nation becomes irreversible.

Shortly afterwards, my 50 or so students filed out of the classroom. Once again, their post-adolescent minds could return to the kind of, um, screwing that qualifies as super.

Peter Ubel is a physician and behavioral scientist who blogs at his self-titled site, Peter Ubel and can be reached on Twitter @PeterUbel.  He is the author of Critical Decisions: How You and Your Doctor Can Make the Right Medical Choices Together.

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  • Sabinal

    i’m not a doc, but I was not impressed by these students. Mainly because I was not there to get details, but they sound so self centered – like the US is the only country to have health care cost problems. They need to look elsewhere and see how they are working AND going broke and perhaps then we can find a solution.

    one thing is clear – as long as people want to live healthy and long, they will demand better care. And as that care increases in technology it will cost. We can have car-insurance type rates if we wanted healthcare advancements to stop at the year 2000 or even 1990. That is the only way to control costs (aka rationing amount of care)

  • Jose A. Jarimba

    Mr. Peter, your students are right. Please, Read and have them read the following book: “The Human Mold prevention from origin”, by, Jose A. Jarimba. This book will help them get to know what is needed to make our Health system better. Here in McAllen, Texas, there are already a lot of people feeling great and enjoying life minus the Doctors. Healthy Regards!

  • http://www.facebook.com/people/Brian-Mckenzie/1419117137 Brian Mckenzie

    take politicians, third party payers and academics out of the system, you will find alot of the graft, corruption, waste, and disparate quality measures fall off the radar. It is personal health, not social village trype, that is where your cure is…… and yes – we are already Super Screwed; because personal responsibility is neither popular nor profitable.

  • http://www.facebook.com/profile.php?id=881580563 Kristy Sokoloski

    In order to fix healthcare everyone needs to get involved in the discussion. Yes, that includes the patients. One of the things that keeps getting talked about is making sure that everyone has access to a Primary Care Physician. Wonderful, but then I keep reading about how the Primary Care Physician is not as valued as they should be. And that’s in addition to reading all the articles that are on both sides of this issue, but one of the blog entries posted on this site got me to thinking a lot. One of the blog entries that was posted by Dr. Rangel said about how patients do not value the Primary Care Physician, and then it led me to this question. How much do patients really know about what all that a Primary Care Physician does? Does anyone know about any surveys that may or may not have been done by either the AMA or the AAFP in order to find this out? It would be interesting to see just how much patients really understand this. I bring this up for another reason. I am now in Nursing School taking my General Education classes, and one of the classes I am taking is Sociology. One of the chapters that we just covered which had to do with the different classes of people in this country and the amount of poverty found in this country. One of the topics mentioned was about those that don’t have access to doctors because they can’t afford to pay, and another chapter later on will delve in to more about healthcare from the Sociological standpoint. And I have been formulating an idea for a project to do in class if required. I am strongly thinking about doing it on the subject of Primary Care Physicians and trying to understand why they are not valued as they should be, including trying to understand how their work helps reduce the cost of healthcare. So, maybe if patients better understood the importance of what a Primary Care Physician’s role is in their care and how they can help the patient with reduction of healthcare costs then maybe that is one step in the right direction of trying to fix the healthcare system. Just a thought.

  • http://twitter.com/Heindoc Michael Hein

    Definition of super-screwed: being super-screwed already, and not knowing you’re super-screwed.