Bigger Health Care Hasn’t Been Better

 

Eleven orthopedic surgeons have resigned from the SSM Health-Wisconsin Dean Medical Group. They’ve decided, after being employees of a large multi-state health system for less than a decade, it’s not for them.  I worked with the orthopedic surgeons and all the Dean Health System physicians for 22 years as the Vice President for Patient Care and Chief Nursing Officer of SSM St. Mary’s Hospital in Madison.  They are among the best. Their exodus could easily escape our notice. It shouldn’t.  It’s part of a much larger, very important story about health care in the U.S.

 

Health care costs have been a concern for years. In 1983, alarm bells were sounding when health care spending reached nearly 10% of the gross domestic product (GDP).  The federal government introduced “fixed reimbursement” to control costs.  Medicare and Medicaid (government insurance for the elderly and poor) would now pay a set amount for care. Health care providers shifted costs to private payers to compensate.

 

About this time the idea of “health care systems” also emerged. In theory, all health care needs under one corporate umbrella would enhance access, improve continuity and outcomes, and lower cost.  It hasn’t worked out that way.

 

40 years later, large health care systems are the norm.  Most health care organizations like SSM have grown through acquisition adding hospitals, nursing homes, home health providers, physician practices, imaging centers, pharmacies, insurance companies and virtually any business associated with health care, concentrating tremendous power in the hands of fewer people.  More decisions are made far from the point of care, and those who know the most about care are too often denied meaningful voice. The U.S. now spends $4.1 trillion on health care annually, nearly 20% of GDP. We don’t have the outcomes we should expect from our massive spending.  The altruistic nuns, who founded what became SSM Health in the early 1900’s, are all gone.  Bigger has not been better.

 

We spend more than enough money on healthcare.  Getting better outcomes at lower cost will require redirection and that will not come without a fight.  Money and power corrupt, and health care is no exception.  Here are some things that are good to know.

 

• More government control is not the answer.  The cost of complying with crushing  government regulations and cost shifting by government payers to the private sector are part of the problem.  Health care company lobbying is nearly $700 million annually, with pharmaceutical companies by far the largest segment.  (Contrast this with $15.8 million in lobbying from gun rights advocates, frequently villainized for political purposes).  When Senator Ron Johnson tried to truthfully engage the country in addressing the fact that Medicare and Social Security are unsustainable as currently configured, his political enemies tried to destroy him.

• Pharmaceutical companies had $20 billion in net income in 2021.  The U.S. market is $560 billion and total market sales for COVID-19 vaccine this year are projected at $124 billion.  The pharmaceutical industry funds 75% of the FDA’s budget – the agency that regulates its products.  The fox is guarding the hen house.  The U.S. is one of only two countries that allows marketing prescription drugs directly to consumers because of its detrimental effects on rational prescribing, cost, and health outcomes. 

• The health insurance industry is only required to spend 80% of premiums on health care cost and improvement. The U.S. health insurance market is greater than $2 trillion.

• Americans are plagued with lifestyle induced chronic illness.  Health requires a significant component of personal responsibility.

• The health care industry and medical professions were complicit in politicizing medical science during the pandemic.  Dissent and debate of emerging evidence are essential to scientific discovery.  Credible professionals who voiced disagreement with government mandates and concerns about vaccines were silenced and threatened with their livelihood.  When the providers are owned by the system, they are easier to control.  This cannot be tolerated.

 

The SSM orthopedic surgeons have stated their intent to pursue a new business model.  They plan to assume financial risk for the outcomes they produce.  Business leaders have responded favorably.  Expect SSM to muster all its resources to block them.  The welfare of the community is not at the heart of the opposition.  They’re highly qualified.  I wish them great success and hope this is a trend.