Valley View

David Pate: Ten reasons to stop fighting and fix health care in U.S.

DAVID C. PATE, M.D., J.D., president and CEO, St. Luke's Health SystemNovember 12, 2013 

David C. Pate

1. Health care spending is unsustainable.

Health care spending as a percentage of the United States gross domestic product is 18 percent, nearly twice that of Organization for Economic Co-operation and Development countries. Annual health care spending per person in the U.S. is about $8,680, nearly two and a half times the average for OECD countries.

We cannot be successful long-term if we are spending more than twice what other countries are on health care.

2. We can't afford the debt.

The U.S. government's debt today is nearly $18 trillion, or $45,000 per person. That's the good news. If you were to estimate our debt on an accrual basis, accounting for debt we have committed to pay in the future such as Social Security and Medicare benefits, then our debt is nearly $90 trillion, or more than $200,000 per person. The Gross Domestic Product of every other country in the world, combined, is a little more than $71 trillion, to put the magnitude of this problem into perspective.

3. We're paying for the wrong things.

At least 30 percent of health care spending is for low-value or even no-value services. This payment methodology is the most prevalent reimbursement system for health care.

4. We're not paying for the right things.

Patients receive evidence-based care less than half of the time, on average, for those conditions with established evidence.

5. We are not having honest conversations with patients with terminal conditions and their families far enough ahead of their deaths.

An increasing number of patients with terminal illness are being admitted to the ICU in the last month of life, and hospice care continues to be underutilized and instituted within days of the patient's death.

These are missed opportunities to help patients and families have better symptom control and a better experience.

6. There's a real problem headed our way.

The epidemic of childhood obesity will cause unprecedented deterioration in the health of our future workforce and significantly add to medical and disability costs at a much earlier age.

7. There aren't enough doctors.

There is a national shortage of physicians, and by 2020, up to 40 percent of current physicians will reach the age of retirement.

8. Patients with chronic illnesses often have 10 or more physicians involved in their care.

Care is too often poorly coordinated, and caregivers often do not have access to all of the patient's medical information, leading to unnecessary duplications and errors.

9. So many of the problems and costs are avoidable.

In the U.S., 40 percent of deaths can be attributed to tobacco use, diet, physical inactivity and/or alcohol. Despite evidence, too many people still do not use helmets when riding bicycles and motorcycles, and do not use seatbelts when riding in cars.

10. We need to focus on standards.

There is significant irrational variation in health care that contributes to unnecessary services, duplication, expense, and in some cases, harm to patients.

St. Luke's is addressing many of these challenges and taking care forward in Idaho to improve the health of the people we serve, provide better care and lower costs.

To learn more, go to http://drpate.stlukesblogs.org.

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drpate@slhs.org

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