HomeFeatures/Opinion We Need to Turn Healthcare on Its Head -- David Moskowitz, MD, for Reform Plans
We Need to Turn Healthcare on Its Head -- David Moskowitz, MD, for Reform Plans
David Moskowitz, MD, for Reform Plans, July 16, 2008
What's your fix for healthcare? We asked readers that question in our July 3 newsletter. Among the answers we received is this one, from David Moskowitz, chairman, CEO, and chief medical officer at GenoMed. Dr. Moskowitz states, "A system that kept you healthy and out of the hospital, so that you could die at home at the age of 125, would actually cost much less than our current one."
Read Dr. Moskowitz's healthcare solution:
I think every American believes that our healthcare system is the most innovative in the world, and that it is constantly striving to improve patient outcomes.
I'm sure people would be shocked to learn that our healthcare system, all $2.2 trillion a year of it, much prefers the status quo. I know I was.
What we've been told is that better clinical outcomes means higher cost--that, in healthcare, "You get what you pay for." The crisis in American healthcare is that it has become prohibitively expensive, with fewer people able to afford it. Currently, 45 million Americans under the age of 65 can't afford health insurance, and the number is rising. The situation is just as grim for those 65 or older. Medicare is predicted to go bust in the next decade.
We're not supposed to mind, because the implicit assumption is that care gets better the more expensive it gets. The only issue is how to pay for it.
In fact, in healthcare, the opposite is true: the more you pay, the less you get. A system that kept you healthy and out of the hospital, so that you could die at home at the age of 125, would actually cost much less than our current one.
Arguing about who will pay the rising cost of healthcare, as the Democrats and Republicans do every decade or two, completely misses this critical point. Unless we turn healthcare on its head, we will continue to get an anti-innovative product.
As in centuries past, medicine still joins battle with disease only once symptoms arise. You get chest pain, you're rushed to the emergency room for a clot-busting drug at huge expense. Nobody gets paid to avert a heart attack, even if they could; they just get paid to treat one. For hundreds of years, medicine's bat tlefield has been the hospital. That 70% of healthcare dollars are still spent in the final year of a patient's life just means that the hospital-based effort is as futile now as it ever was.
Why? Because disease is a superior opponent; our only hope is to come out strong in the first quarter, not the fourth.
Until recently, beating disease was impossible. Medical genomics, the science of which genes cause which disease, finally gives us a chance. We're finally seeing how disease gets triggered. It's like having a map for the first time. Medical genomics moves our age-old battle with disease from the hospital to the outpatient clinic, from the end of life to our middle age. We can score points early in the course of the disease, in the first quarter. For example, knowing even a single disease-causing gene makes it possible to reverse kidney failure, the most serious form of cardiovascular disease (1).
By keeping people healthier and out of the hospital, we can save money. So-called preventive molecular medicine can already slash healthcare costs perhaps by as much as a third over the next decade. This will clearly be a great victory for medicine and society, but a huge defeat for the business of medicine. Hospitals and the insurance plans that feed and are fed by them will not go quietly.
Although it has been possible for the past five years to prevent 90% of kidney failure, that hasn't happened. The professional kidney community that society relies on to communicate any breakthroughs in kidney medicine has kept its silence (2).
That's because the incentive in both the public and the private sectors is to drive up the cost of healthcare. What nonprofit agency wants to make the same mistake that the March of Dimes did by defeating polio in the 1950s and thereby eliminate its raison d'etre? Bureaucrats in the public sector are just as guilty as insurers in the private sector. Nobody wants their volume (referred to as a "budget" in the public sector) reduced. Nobody wants to lose their job. And it's not their money or their lives on the line, just their job.
I should know. Neither Medicare, which pays over $20 billion a year for kidney dialysis and transplantation, nor the private sector, nor any professional kidney group, nor any non-profit kidney association, has shown the slightest interest in my "recipe" to prevent 90% of kidney failure (1). We even use generic drugs!
Al Gore got it wrong. The pharmaceutical companies are not the bogeymen; the hospitals and the insurers are, in both the private and the public sectors. Nonprofits are no better than for-profits in clinging to the lucrative status quo at the expense of the patients they supposedly serve.
Switching to a single-payer system, as the Democratic Party suggests, will not solve the problem. Neither Canada nor the United Kingdom nor any other single-payer system in Eu rope has shown any interest in our method for preventing kidney dialysis either. The lesson here? Bureaucrats don't want their budget cut.
So what is the solution for a system that's not even aware of how corrupt it is?
The truth, of course. If you want better outcomes, the first step is to pay attention to them. Currently, neither sector even reports clinical outcomes. So just require that the public sector, the only one that Congress has full control over, report patient outcomes. The private sector will follow suit, if only to keep patients from voting with their feet and flocking to the public sector.
Then let all the healthcare systems out there, public, private, or whatever combination, compete on patient outcomes--a kind of "arms race" equivalent that would actually benefit citizens for a change.
Let Congress require that Veterans Administration, Medicaid, and Medicare patients have their clinical outcomes reported, alon g the lines of the U.S. Renal Data System. Although Congress began funding kidney dialysis and transplantation in 1973, it wasn't until around 1988 that the outcome of kidney failure patients was first reported. The results were (and continue to be) dismal: the average life-expectancy for a 65-year-old man starting dialysis is less than 3 years.
If dialysis outcomes for different healthcare systems were posted on a website, then patients could at least choose which healthcare system to get dialyzed in. (It wouldn't make much difference). If healthcare systems then started reporting how many people with diabetes or high blood pressure actually had their kidney function get better, as I've published is possible (1), then those healthcare systems should gain market share, while their costs decreased.
I also have a simple idea for how to provide doctors for the 45 million uninsured too poor to afford health insurance. It involves giving the VA back to the Publ ic Health Service, rather than allowing the VA to downsize by 50% once the Korean War and WWII veterans die (starting in 2010). But that's another discussion. Until patient outcomes are reported, it doesn't matter what healthcare system we have; it will continue to exploit the poor patients.
Former Secretary of State George Shultz discusses his new book, "Putting Our House in Order: A Guide to Social Security and Health Care Reform." From the World Health Care Congress in Washington, DC.
Features/Opinion 
