This is an excellent summary. I completely agree with your assessment. Now, the question is how each of us can effectively organize change while managing a busy practice and family life. My focus, at least, is to continue to promote healthy lifestyle changes to reduce the risk of cancer.
I think this is the best thing that any of us can do on an individual basis for our patients. Even as a reconstructive surgeon I try to do what I can to promote a healthier lifestyle. There are so many times a surgery can fail before reaching the OR due to chronic health issues. But there is only so much we can do. The systems change that’s needed…well, that’s a horse of a different color.
In reality, physician compensation accounts for only about 8% of total U.S. healthcare expenditures, while administrative costs can consume 25–30% of spending in the fragmented insurance landscape.
This is just such an insane stat. I can’t think of another industry with more middlemen.
Thank you! I agree with what you wrote! We need to leverage the political and social determinants of health. There is a lot we can do individually as physicians and patients. But without systems change, we will continue to struggle.
Thank you! You nailed it succinctly and I'm so happy you looked at the issue systemically. I kept thinking "if I were any of the players in the system, what would I do?". The great economist Herb Simon talked about "satisficing" solutions to complex problems that only meet minimal requirements and said that sometimes "good enough" is well ... Good enough. Not in healthcare where the stress on the system only grows and pockets of change and pilot projects seldom lead to real systemic change. I do believe that health starts with the patient. There has to be accountability where each person is regularly asked "how committed are you to maintaining your health?". Those not expressing commitment are putting up a red flag on their mental health. Those who say they're committed then bear the responsibility of showing it and "coaches" and networks need to be available to track and support associated, personalized habits. The patient needs to understand very early that the chronic condition they're on a path to "really sucks" and most damage isn't preventible or reversible with a pill. Employers can commit to a work environment that facilitates rather than disrupts healthy habits. Medical professionals can evolve to a focus on maintaining wellness in most and attending to the inevitable accidents, non-chronic conditions and more genetically driven diseases. Scapegoating needs to stop. As you pointed out, everything is so intertwined that the only common feature is the need to maintain profit. When institutional investors, who wield incredible power, squeeze pharma companies, insurers, and everyone else for profit over "risky" innovation we have to realize that is our 401ks doing the talking and we gave them the right "to vote our shares". Understanding the issue is the key and I'll be recommending this piece as a great entry point.
There are challenges in each step you bring up, but impossible to run through in a digital platform like this without requiring a tome to navigate all the ideas (I am hoping to do that with a nonfiction manuscript I’ve been working on).
To put it simply, it requires individual AND collective responsibility.
Very true: prevention needs infrastructure, ritual, incentives, and repeatable social form. It seems no one is paid early enough, long enough, or close enough to daily life to make prevention biologically plausible. What would the system look like if it were built around adherence and environment rather than rescue?
I don’t think we’ll ever escape disease. I think it is likely to remain a component of the human condition - at least as far as I can tell. But there is so much information on how we can better manage the system of healthcare and the systems that influence human health. Since chronic illness is the major cost driver, that is where we should observe and leverage the upstream issues that impact and influence that aspect of disease. The challenge is navigating the political and economic systems that shape health. Those entrenched interests are likely the hardest to move.
Agreed, escaping disease is neither possible nor really the frame. The hard part, as you say, is that entrenched interests are built around transactions, while prevention requires continuity. So for now, continuity falls back on the individual, which is both practical and somewhat unfair 😉
This is an excellent summary. I completely agree with your assessment. Now, the question is how each of us can effectively organize change while managing a busy practice and family life. My focus, at least, is to continue to promote healthy lifestyle changes to reduce the risk of cancer.
I think this is the best thing that any of us can do on an individual basis for our patients. Even as a reconstructive surgeon I try to do what I can to promote a healthier lifestyle. There are so many times a surgery can fail before reaching the OR due to chronic health issues. But there is only so much we can do. The systems change that’s needed…well, that’s a horse of a different color.
In reality, physician compensation accounts for only about 8% of total U.S. healthcare expenditures, while administrative costs can consume 25–30% of spending in the fragmented insurance landscape.
This is just such an insane stat. I can’t think of another industry with more middlemen.
Maybe what you’ve written in your article becomes reality and AI starts to replace those administrative middlemen!
Thank you for this excellent analysis. I’ve given your article a prominent link in an update to my post:
https://drmick.substack.com/p/corporate-wealth-versus-peoples-health
Thank you! I agree with what you wrote! We need to leverage the political and social determinants of health. There is a lot we can do individually as physicians and patients. But without systems change, we will continue to struggle.
Thank you! You nailed it succinctly and I'm so happy you looked at the issue systemically. I kept thinking "if I were any of the players in the system, what would I do?". The great economist Herb Simon talked about "satisficing" solutions to complex problems that only meet minimal requirements and said that sometimes "good enough" is well ... Good enough. Not in healthcare where the stress on the system only grows and pockets of change and pilot projects seldom lead to real systemic change. I do believe that health starts with the patient. There has to be accountability where each person is regularly asked "how committed are you to maintaining your health?". Those not expressing commitment are putting up a red flag on their mental health. Those who say they're committed then bear the responsibility of showing it and "coaches" and networks need to be available to track and support associated, personalized habits. The patient needs to understand very early that the chronic condition they're on a path to "really sucks" and most damage isn't preventible or reversible with a pill. Employers can commit to a work environment that facilitates rather than disrupts healthy habits. Medical professionals can evolve to a focus on maintaining wellness in most and attending to the inevitable accidents, non-chronic conditions and more genetically driven diseases. Scapegoating needs to stop. As you pointed out, everything is so intertwined that the only common feature is the need to maintain profit. When institutional investors, who wield incredible power, squeeze pharma companies, insurers, and everyone else for profit over "risky" innovation we have to realize that is our 401ks doing the talking and we gave them the right "to vote our shares". Understanding the issue is the key and I'll be recommending this piece as a great entry point.
Absolutely to all of this!
There are challenges in each step you bring up, but impossible to run through in a digital platform like this without requiring a tome to navigate all the ideas (I am hoping to do that with a nonfiction manuscript I’ve been working on).
To put it simply, it requires individual AND collective responsibility.
Very true: prevention needs infrastructure, ritual, incentives, and repeatable social form. It seems no one is paid early enough, long enough, or close enough to daily life to make prevention biologically plausible. What would the system look like if it were built around adherence and environment rather than rescue?
I don’t think we’ll ever escape disease. I think it is likely to remain a component of the human condition - at least as far as I can tell. But there is so much information on how we can better manage the system of healthcare and the systems that influence human health. Since chronic illness is the major cost driver, that is where we should observe and leverage the upstream issues that impact and influence that aspect of disease. The challenge is navigating the political and economic systems that shape health. Those entrenched interests are likely the hardest to move.
Agreed, escaping disease is neither possible nor really the frame. The hard part, as you say, is that entrenched interests are built around transactions, while prevention requires continuity. So for now, continuity falls back on the individual, which is both practical and somewhat unfair 😉