The Affordable Care Act is more of our broken health care model


Every week we read another article on the fuzzy math and ridiculous mark-up for our routine healthcare. Do your own research; see Elizabeth Rosenthal’s article in a recent Sunday New York Times, the $2.7 Trillion Medical Bill or Steven Brill’s lengthy tome in Time, Bitter Pill.

We spend, and will continue to spend, more on healthcare than any other nation in the world and yet we are 38th in healthcare rankings according to the World Health Organization. America has the most efficient markets in virtually every other sector except healthcare.  Unfortunately, we are just beginning to see that our landmark health reform law, the Affordable Care Act, is no improvement and it will give us less for more.

America has had a broken model for our healthcare for nearly two generations (50 years). What is broken is our dependence upon 3rd-party middleman (government, insurers) when we need healthcare. Even though 70 percent of our health care is elective, non-emergent and provided outside of a hospital we allow middlemen to control all transactions.  These middlemen obscure all real pricing and insulate us from normal market dynamics and price-competition.  This prevents the development of a virtuous cycle between consumers (us patients) and providers (doctors, clinics, hospitals).

Thus, instead of win-win healthcare where individuals are paying attention to costs and are motivated to stay healthy (by saving money), we have lose-win-lose healthcare where everyone loses but the middlemen—have you ever noticed that there is always a crane in a hospital parking lot? Our poor collective health, with our obesity and diabetes epidemics, may be just one indicator of how decoupling the patient from their healthcare is a failed strategy.

America needs to move from an “open bar,” everything is covered and no one is paying attention to costs model, to a “cash bar,” consumer-driven healthcare model. Patients would pay attention to costs, have leverage for access to care (which will be important moving forward) and be incentivized to have healthy behaviors. Providers would be more correctly focused on the patient and be motivated problem solvers for the patient—providing higher quality and more convenient care.  This model for healthcare is more holistic and ethical too; by engaging and incentivizing the recipients of care it recognizes the interdependence of all stakeholders while giving patients and their families the ultimate choice of how their healthcare is managed.

America needs to think differently about healthcare and embrace a new consumer-driven healthcare model and paradigm: one that is decentralized, empowered, and collaborative.  It is no coincidence that the two most competitive economies in the world, Singapore and Switzerland, have such a model. Consumer-driven healthcare will make us more fiscally and physically competitive.

Regrettably, the Affordable Care Act is more of our tired and broken health care model; increasing 3rd party dominance, centralizing control, fueling unprecedented market consolidation. This has already increased our costs and decreased our choices and access to care.

Matt McCord is an anesthesiologist. He is founder, Michigan Alliance for Sustainable Healthcare, and can be reached on Twitter @MattMD.


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