About 30 miles east of LA, on the quiet tree-lined campus of Claremont Graduate University, sunlight pierces the ornately covered windows of a lower-level classroom in Harper Hall. A glow is cast upon the 25 students of Dr. Debbie Freund’s health policy course; PhD candidates and practicing physicians among them.
Many of these bright young scholars will go on to take leadership roles in health policy, public health, IT and medical research. I eagerly await their contributions.
The students in this room are impatient, sick of waiting for the transformation of American medicine. We have that in common. Most of them have worked in community-based programs – experiences that opened their eyes to the failed policies and practices of today’s health care system. In so doing, they’ve acquired practical knowledge of the programs and approaches that lead to better health outcomes. They’ve also learned, first-hand, what needs to change.
I’m speaking with them at the request of Professor Freund, who has assigned Mistreated: Why We Think We’re Getting Good Healthcare – and Why We’re Usually Wrong as a textbook. I’m eager and anxious to hear the students’ thoughts on my book and the role integration, technology, prepayment and physician leadership will play in the transformation of health care. After two hours of thoughtful discussion and debate, I leave the classroom confident that the future of health care is in good hands.
Strange(r) Things are happening in health care
During lunch, my conversation with the Claremont students shifts to – of all things – the popular Netflix series Stranger Things. If you haven’t seen it, the show takes place in a quiet Indiana town called Hastings, which sits smack dab on top a portal to another dimension: a subterranean swampland known as the “Upside Down.”
As I flew from California to Washington, D.C. that afternoon, something rather astonishing happened. I, too, passed through a portal from one reality to another.
Before telling you what I saw on the other side, let me begin with the hopeful, assuring reality I left behind. The students I met on the Claremont campus, like the friendly small-town characters we’ve come to know on Stranger Things, genuinely care about their neighbors and the health of the community.
A prime focus of our classroom discussion centered on “social determinants of health.” These environmental factors, such as where we are born and raised; where we work, play and socialize, have a far greater impact on health outcomes than traditional medicine does. The students understood that some of society’s biggest problems, including adverse childhood events (ACEs)and intimate partner violence (IPV), are taking a major toll on our nation’s mental and physical well-being. For instance, researchers have found a direct correlation between ACEs and problems in adulthood, including mental illness, substance abuse and premature death. Likewise, women in abusive relationships are 70% more likely to develop heart disease and 80% more likely to experience a stroke.
But the mere recognition of these social-health problems isn’t the only thing that distinguishes this group of 20-somethings from the current health care establishment. They also take the long-term view on the imperative for solving American health care’s economic woes.
With their expertise in statistics, the students recognize the threat posed by rising medical inflation. They’ve studied up, crunched the numbers and know what will happen if the cost of healthcare absorbs 30% of the GDP by 2040, compared with 18% today. The consequences will be severe and far-reaching: Our nation’s infrastructure, education system and economic health will erode.
Throughout our time together, I was most impressed by students’ strategic thinking and the forward-facing nature of their questions: What will happen if climate change worsens and lung disease proliferates? What if the obesity epidemic continues and the incidence of diabetes increases? What if the government and American medicine fail to address growing rates of depression, mental illness and opioid abuse? These students understand that if we don’t tackle these pressing health care issues, the long-term consequences will overwhelm any attempt at short-term solutions.
Evidenced by the ideas and approaches embraced in the classroom, I believe the next generation of health care leaders offer the best hope for reversing our nation’s failing health. Though a solution might also emerge from today’s leading businesses, it is highly unlikely the necessary fixes will come from the folks on Capitol Hill.
Visiting the “Upside Down”
When I arrived in D.C. that afternoon, following my visit to Claremont, I began meeting and spending time with policymakers and elected officials. It was then that I realized I’d passed through one dimension and entered the “Upside Down.”
Though the American public has long disapproved of the gridlock and partisanship of the U.S. legislative branch, the problems are now multiplying before our eyes. Washington is embroiled in partisan battles and policy stalemates now more than ever. Trade wars, sex scandals and ongoing legal investigations dominate the conversations in the halls of Congress, which are overflowing with lobbyists and attorneys, pushing personal agendas to profit for their clients.
Among them are representatives from the hospital industry and physician specialty societies, whose combined focus is self-protection and status quo maintenance, not driving down health care costs or weeding out unnecessary tests and treatments. Drug companies, meanwhile, are ramping up their lobbying efforts, hoping to extend patents and loosen industry regulations, rather than make generics readily available for people who can’t afford high-priced prescriptions.
The mood in D.C. felt like a far cry from the socially-conscious, problem-solving optimism I found on the campus of Claremont. In contrast to the students’ energizing, inspirational and refreshing points of view, Washington’s elected officials are focused on how to cut back – not expand – health insurance. Many of them believe slashing coverage is a good way to reduce costs. It isn’t. Maximizing clinical performance (making care delivery more effective, innovative and efficient) is how we will improve the quality of care and lower costs.
It’s clear that effective health care solutions will need to come from somewhere beyond the Beltway.
Saving the day
In Stranger Things, it takes the courage of a young character named “Eleven” to save the town (and all of humanity). Though I doubt the students at Claremont possess her supernatural powers, their ideas may prove just as powerful in the fight to save American health care.
Here are the top five solutions I extracted from our time together:
1. Coverage matters. If we want the best health outcomes for our nation, Americans need easy access to care. To pretend otherwise is foolish. In a nation as rich as ours, 30 million uninsured people is unacceptable. Without health coverage, people can’t access care. And without care, people get sick, suffer and die.
2. Cost matters. Unless we increase the performance of our physicians and health systems, premiums and out-of-pocket costs will rise faster than people’s ability to pay. If patients can’t afford care, they’ll have no choice but to delay getting it, often until it’s too late.
3. Prevention is better than intervention. Chronic diseases account for 75% of the nation’s aggregate health care spending. That number, believe it or not, is still growing. The best way to treat chronic illness is to avoid heart attacks, strokes and cancer. And the best way to do that is through highly effective prevention measures, which include controlling blood-pressure, reducing blood lipids and screening for colon cancer.
4. Technology holds massive promise. Technology drives today’s consumer culture. But if you look behind the reception desk of your local doctor’s office, there’s a good chance you’ll see an electronic health record system that fails to make your information available to other doctors and hospitals in the area. Comprehensive electronic health records, video visits, mobile health apps and digital checklists are just a few of the proven tools that could raise the quality and lower the cost of care. As millennials, the students at Claremont and their counterparts at other universities understand the role modern technology will play in health care’s future, particularly when it comes to emerging solutions like blockchain technology and artificial intelligence.
5. Social determinants are powerful. The United States spends trillions of dollars on expensive medications and interventions that barely move the needle on national health outcomes. Investing even a fraction of those dollars in helping high-risk individuals (e.g., those who have experienced ACEs/IPV, the poor and people experiencing psychological problems) would produce major health benefits for decades to come. Our country remains in relative denial about the ravages of abuse, mental illness, and excess consumption of alcohol and cigarettes. We can’t solve those problems until we recognize them. I’m thankful the next generation of health care leaders do.
Having visited two worlds, the Claremont campus and our nation’s capital, I emerged from the experience with equal parts optimism and doubt.
The prevailing mentality in Washington is transactional and short-term. Rather than asking how we can transform care delivery in five to 10 years, the lens rarely extends beyond the 2018 mid-term and 2020 presidential elections. Unfortunately, solutions to our country’s biggest health care issues defy short-term thinking. Looking inside out nation’s capital for answers feels futile. Expecting the legacy players – be they hospitals, insurance companies or the pharmaceutical industry – to drive change is wishful thinking.
By contrast, the students at Claremont recognize that the system is broken. Though the obstacles they face resemble the sky-darkening antagonists of Stranger Things, I’m optimistic about their chances to succeed. The degree of difficulty will be enormous, but they are motivated and impatient enough to make tomorrow dramatically better than today. Unfortunately, we’ll have to wait for “next season” to find out how they do.
Robert Pearl is a physician and CEO, Permanente Medical Groups. He is the author of Mistreated: Why We Think We’re Getting Good Health Care–And Why We’re Usually Wrong and can be reached on Twitter @RobertPearlMD. This article originally appeared in Forbes.
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