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RED HOT Contributors


Mandating Individual Health Accountability To Help Fix Our Healthcare Crisis



I love health policy, healthcare technology, and using ‘corkscrew’ thinking to find solutions for big problems.  Perhaps no problem looms larger today than our current healthcare crisis and its financial implications for our future.  

The U.S. healthcare system needs more than a healthy shot in the arm – it needs a cure.  Premiums continue their upward surge, more Americans are going into debt, less workers funding a growing Medicare base, a heavy shift on enrollees to Medicaid coverage, increased ACA subsidies, higher drug prices, increasing cost shifting and people living longer.

In the last decade, all the top healthcare analysts, hospital, drug and insurance leaders, medical school experts, well-followed bloggers, public policy wonks, foundations, think tanks, and politicians have had plenty to say.   Many companies across nearly all healthcare business sectors have grown, yet the American consumer continues to be hit he hardest.

Current evolving solutions we have for the fix of healthcare includes:  the Triple Aim, ACO’s, private and public-sponsored medical research, disease fundraising, population health management, EHRs, high-tech abuse/fraud solutions, new drugs, end-of-life talks, Obamacare, plus the future of pay-per-value.  

Everything about our healthcare crisis screams more selective utilization, greater efficiency, and lowering costs.  The red oil light on the healthcare driver dashboard says there is a bigger issue.  Something that when fixed, will provide a greater fix for generations to come.

The light alerts us on the fact that out of the $3 Trillion dollars per year spent on healthcare, 86% of those costs are for chronic disease.  Many of which can be prevented, delayed in their onset, or better managed far earlier.  Per the Centers for Disease Control (CDC), the costs and figures are simply staggering.  If the world’s largest company was going under, their underlying financials couldn’t look any more crippled.

We have been looking at our national healthcare crisis in the wrong way.

The solution is not in providing everyone with health coverage, but in taking strong, legal steps to teach, coerce and even mandatethat the majority of American children and adults become healthy, through individual accountability.

‘Mandate’ hits a nerve, especially to all those, like myself, that value the strength of our individual freedoms.  Mandating individual health clearly lends itself in dissuading people from at least engaging in products and services, such as tobacco, alcohol, and fast food.

The idea for mandating individual health accountability is largely based on a large amount of Americans that have both historically and consistently shown that they chose to not value their health.  Health that is not valued is subsequently not properly managed.  Improper management leads to the growth of sustained drivers, thereafter lending themselves to the onset chronic disease(s), which is clearly the major cost driver of our healthcare crisis.

For starters, nearly 50% of all American adults (117 million) have a chronic disease and 25% have at least two.  More than a third of our country (35%) is classified as obese. Nearly half of US adults (47%) have at least uncontrolled high blood pressure, uncontrolled high LDL cholesterol, or are current smokers.

“Hey – that is the individual’s choice, and they has to live with the results.”  

Sure…personal responsibility is key.  But for the healthcare markets, chronic disease in one person affects everyone in the system.

We know subsidies and public coverage, such as Medicare, CHIP, Medicaid run off taxpayer money; and private insurance prices group and individual premiums from risk pools.  So there is no misunderstanding…today’s unhealthy people cost healthy people money today, and in future generations to come.

Most everyone knows that eating a carrot is better than a donut.  That running two miles a day beats a pack of smokes.

If that’s the case, why aren’t people making the change?  

Simple…they do not value their health.  Therefore, they do not take actions to improve or maintain it.  

Individuals valuing their health on a mass scale is the answering to lowering chronic disease rates over time.  Lower disease rates lowers cost for care, resulting in more affordable healthcare for everyone.

ACO’s, improving EHRs, increasing pay-per-value reimbursement helps lower costs and creates efficiency, but it does very little to drive individuals to value their health.  These are business-type decisions, which affect businesses first and people second.

When someone make a decision to choose nearly anything, there are only two reasons used:  either to gain or have the potential to gain pleasure, or to avoid a large amount of stress or pain.  One example might be in choosing to eat a chocolate candy bar, craving the enjoyment of the sweet taste.  Another might be the person who quits smoking, only after their first heart attack, where the strong possibility of death sets in.

But check this.  For most people who are 25 and under, if they already ‘feel good’ physically, neither of those triggers are in play.  And by the time they ‘feel bad’, many chronic diseases may already have had a strong irreversible foothold (with damage) for years or decades.  Early detection for everyone is tremendous needed.

Many young don’t go to the doctor because they feel good.  While paying premiums but not utilizing care works great for insurance risk pools, it runs completely contrary to the nature of objective testing to gain knowledge and become empowered to make better decisions from such.

The initial motivator to get people to value their health, is not public education, throwing large data points at them, getting them on high-deductible healthcare plans, or using fear marketing.  It must be to create an instance where they will get massive amounts of pain from not going to get a checkup or screening.  For that reason, I believe every American, insured or not, must be required by law, to have routine physicals and screenings.

Basic Outline of Program:

  • Repetitive and selective screenings, depending on gender and age
  • Those who do not get their screening receive a financial penalty, paid directly from the individual, from their taxes, through their paycheck, or deducted from their social program or subsidy benefits.
  • The patient portion for screenings, whether insured or not, are covered by subsidies.  Yes, I said subsidies.
  • Results are tracked.  Individuals counseled.  Further results on subsequent actions tracked.

A plan ready to go?  No way – lots of improvement needed.  But the premise is right, because in the long run it runs completely in alignment with human behavior.

Yes, this plan will drive up costs on the front end.  But it took us a lot of time to get to this healthcare crisis, and it will take time to undo.  If we believe that we can find a short-term solution to reverse this, we are kidding ourselves.

The most important result is that when our crisis becomes better managed and costs drop, it will remain well-managed, so we never get to this position again.

There will be those who claim individual rights will be lost, if and when such coercion takes place.  One is clearly reminded of the PPACA and the positioning of it being a tax.  But look, if we didn’t have such nasty, costly surprises on the middle and back-end portions of our lives, we wouldn’t have to do this.

Perhaps if doctors, insurers, drug companies, hospitals and other medical services reduced their revenues, affordability would be in hand.  Reality check guys – the U.S. healthcare sector is growing faster than any other in the U.S. Companies, employees and shareholders are not going to reduce their financial interests and current way of life for the average American consumer to afford care.  The fact that ‘for the people’ ACA plans promote cost-shifting is a clear sign of this.

We need something new.  Not something to work against businesses, but to work for people.  People can then, with better personal health data, be motivated to gain more than ever in their current and future health.

Americans have always been strong enough to call upon resolve and forward thinking.  But now we live in the ‘what’s in it for me’ time.  Sometimes mandates are necessary to get people to see the importance of helping their fellow man, instead of themselves.

People are dying unnecessarily.  They will do so in the future if we don’t stand for more than ourselves. Let’s come together to give more people the chance to make better decisions and live healthier lives.

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