Rosenthal Demystifies America’s Health Care System and How to Fix It
“When beating cancer costs $17,000 a month, what do you do?” read the newspaper headline. “1,495 Americans describe the financial reality of being really sick” reads another. It’s no wonder that health care weighs heavily on the minds of America’s voters as they head to the mid-term polls.
That’s no surprise to Frank Fear, Jr., former vice president of a community hospital and current chief information officer at a regional health system. It’s no surprise to his father, Frank Fear, Sr., a cancer survivor.
Cancer had an indelible impact on Fear Sr.—and not just because of the disease. It was also because of the cost, which totaled tens of thousands of dollars. Fear’s cost-share was manageable. He had employer-sponsored health/medical insurance.
Fear, Sr. was fortunate. Many are not. That’s a problem. It’s America’s problem.
And it’s why Elisabeth Rosenthal’s An American Sickness is such an important book. A physician and journalist, Rosenthal shares her grounded perspective understandably and persuasively. “In the past quarter century,” she begins, “the American medical system has stopped focusing on health or even science. Instead, it attends more or less single-mindedly to its own profits.” (p. 1)
Profit-making isn’t a new story and it’s not even a bad story, either—at least on its face. It becomes a problem when for-the-public-good operations get out of balance, focusing too much on money and not enough on public obligations.
To make that point, Rosenthal analyzes the system’s components—insurance, hospitals, physicians, pharmaceuticals, testing services, medical devices, billing, and general management. The centerpiece of her critique is what she labels, “Economic Rules for the Dysfunctional Medical Market” (p. 8).
If you read nothing else from this book, read that material! The reason? Rosenthal pinpoints what needs to change, things like: More treatment is always better. Treatment is preferable to a cure. There’s no such thing as a ‘fixed price.’
Rosenthal doesn’t believe our current plight is caused by bad people doing bad things. Indeed, she recounts story after story of people and organizations doing good things. They share a common characteristic, though: swimming against the tide trying (as hokey as it may sound) to do the right thing.
What’s the answer? Rosenthal’s answer is clear: “return the system to affordable, evidence-based, patient-centered care” (p. 328). For that to happen, she says, “we need to…become bolder, more active and thoughtful about what we demand in health care and the people who deliver it. We must be more engaged in finding and pressing the political levers to promote the evolution of the medical care we deserve” (p. 329).
The “we” to which Rosenthal refers is us— everyday citizens. She’s right, but there’s a hitch, and a big one, too. Rosenthal’s advice applies to other areas in need of public reform (the cost of public higher education, for example), which require citizens to roll up their sleeves, be bold and knowledgeable, and get the political system to work as it should.
In all of those situations, resolution also requires ‘smarts,’ including the ability to figure out solutions that don’t generate a new set of problems. That’s especially important when change-seekers want BIG change (as they do in health care) by replacing existing systems with entirely new ones. (For Rosenthal’s critique of the single-payer model, go here).
That’s why the option we prefer involves fixing the system that exists in America today—the market-based system. That system isn’t the problem. The problem is that it’s not patient-centered.
What would it take to make that happen? First, the system needs to operate the way that other (and perfectly sensible) customer-driven systems work. And, second, the system needs to be wellness- not illness-focused.
Fixing the first problem means making costs more transparent and for health vendors/providers to be more accountable. Rosenthal gives plenty of examples of how to do both, including providing patients with upfront figures regarding the full costs of medicines, tests, and medical interventions—even enabling patients to price-compare. Doing that just makes common sense.
The second matter involves changing the mindset that drives the system, including the way that many of us think about health, doctors, and hospitals. Rosenthal gives examples of how organizations, states, and the Federal government have incentivized the health system to keep people healthy vs. paying them to treat patients when they’re sick. Examples include the Boeing Company (p. 289) and the State of Maryland (p. 298). Another example is Medicare Advantage.
What’s it all mean? The clock is ticking, just as it is with other critical issues facing America (e.g. climate change). In the meantime, too many people are being hurt as we stumble around trying to figure out how to improve the system.
At issue is figuring out what change is workable (politically and economically) and how to make change a reality. It’s with those objectives in mind that Elisabeth Rosenthal gives America a get well card—how to figure out both.
Frank Fear, Jr. is Chief Information Officer at Covenant Healthcare (Saginaw, MI), a non-profit health care system that serves twenty counties in central and northeast Michigan. Frank served previously as vice president at Memorial Healthcare (Owosso, MI), a non-profit hospital offering inpatient and outpatient services to those living in its 100,000-person service area. He received a B.A. in psychology from Albion College and graduated from Michigan State University with an M.A. in counseling psychology.
Frank A. Fear, Sr. is professor emeritus, Michigan State University, where he served as a faculty member and worked in a variety of administrative positions. He is primarily interested in how public and nonprofit institutions serve the public good. Frank currently works as Managing Editor/columnist at The Sports Column (Baltimore, MD) and writes regularly about social issues for the Los Angeles-based, LA Progressive.